
Class _JCv'llAl 



Book 



A^§: 



GotPghtN". 



»101 



COPYRIGHT DEPOSIT. 



? Idt^u? 



T^HAT right living should be the fourth "R** in edu- 
**• cation. 

npHAT home=making should be regarded as a pro- 
fession. 

npHAT health is more the business of the individual than 
of the physician. 

*" I ^HAT most illness results from carelessness, ignorance, or 
intemperance of some kind. 

npHAT as many lives are cut short by unhealthful food and 
diet as through strong drink. 

npHAT the upbringing of children demands as much study 
as the raising of cattle. 

npHAT on the home foundation is built all that is good 
in state or individual. 

^ , as the 

earnmg ot the money. 

npHAT economy does not mean spending a small amount, 
but in getting the largest returns for the money expended. 

npHAT the home-maker should be as alert to make pro- 
gress in her life-work as the business or professional 
man. 

npHAT the most profitable, the most interesting study for 
w^omen is the home, for in it center all the issues of 
life. 

npHAT the study of home problems may be made of no 
**• less cultural value than the study of history or literature 
and of much more immediate value. 

-—American School of Home Economics 



npHAT the spending of money is as important 
earnine of the monev. 



THE LIBRARY 

) 
OF 

HOME ECONOMICS 

A COMPLETE HOME-STUDY COURSE 

ON THE NEW PROFESSION OF HOME-MAKING AND ART OF RIGHT LIVING; 

THE PRACTICAL APPLICATION OF THE MOST RECENT ADVANCES 

IN THE ARTS AND SCIENCES TO HOME AND HEALTH 

PREPARED BY TEACHERS OF 
RECOGNIZED AUTHORITY 

FOR HOME-MAKERS, MOTHERS,- TEACHERS, PHYSICIANS, NURSES, DIETITIANS, 

PROFESSIONAL HOUSE MANAGERS, AND ALL INTERESTED 

IN HOME, HEALTH, ECONOMY AND CHILDREN 

TWELVE VOLUMES 

NEARLY THREE THOUSAND PAGES, ONE THOUSAND ILLUSTRATIONS 

TESTED BY USE IN CORRESPONDENCE INSTRUCTION 

REVISED AND SUPPLEMENTED 




CHICAGO 

AMERICAN SCHOOL OF HOME ECONOMICS 
1907 



LIBRARY of C0NQR£S8 

OntOoDi- Received 

0LAB8 A XXQiNo. 



Copyright, igo7 

BY 

Home Economics Association 

Entered at Stationers' Hall, London 
All Rights Reserved. 



AUTHORS 

ISABEL BEVIER, Ph. M. 

Professor of Household Science, University of Illinois. Author U. S. 
Government Bulletins, "Development of the Home Economics 
Movement in America," etc. 

ALICE PELOUBET NORTON, M. A. 

Assistant Professor of Home Economics, School of Education, Uni- 
versity of Chicago ; Director of the Chautauqua School of Domestic 
Science. 

S. MARIA ELLIOTT 

Instructor in Home Econom'^s, Simmons College; Formerly Instruc- 
tor School of Housekeeping-. Eoston. 

ANNA BARROWS 

Director Chautauqua School of Cookery ; Lecturer Teachers' College, 
Columbia University, and Simmons College ; formerly Editor "Ameri- 
can Kitchen Magazine;" Author " Home Science Cook Book." 

ALFRED CLEVELAND COTTON, A. M., M. D. 

Professor Diseases of Children, Rush Medical College, University of 
Chicago; Visiting Physician Presbyterian Hospital, Chicago ; Author 
of " Diseases of Children." 

BERTHA M. TERRILL, A. B. 

Professor in Home Economics in Hartford School of Pedagogy; 
Author of U. S. Government Bulletins. 

KATE HEINTZ WATSON 

Formerly Instructor in Domestic Economy, Lewis Institute; Lecturer 
University of Chicago. 

MARION FOSTER WASHBURNE 

Editor "The Mothers' Magazine;" Lecturer Chicago Froebel Asso- 
ciation; Author " Everyday Essays," "Family Secrets," etc. 

MARGARET E. DODD 

Graduate Massachusetts Institute of Technology ; Teacher of Science, 
Woodward Institute. 

AMY ELIZABETH POPE 

With the Panama Canal Commission ; Formerly Instructor in Practical 
and Theoretical Nursing, Training School for Nurses, Presbyterian 
Hospital, New York City. 

MAURICE LE BOSQUET, S. B. 

Director American School of Home Economics ; Member American 
Public Health Association and American Chemical Society. 



CONTRIBUTORS AND EDITORS 

ELLEN H. RICHARDS 

Author " Cost of Food," " Cost of Living," " Cost of Shelter," " Food 
Materials and Their Adulteration," etc., etc.; Chairman Lake Placid 
Conference on Home Economics. 

MARY HINMAN ABEL 

Author of U. S. Government Bulletins, " Practical Sanitary and Econ- 
omic Cooking," "Safe Food," etc. 

THOMAS D. WOOD, M. D. 

Professor of Physical Education, Columbia University. 

H. M. LUFKIN, M. D. 

Professor of Physical Diagnosis and Clinical Medicine, University of 
Minnesota. 

OTTO FOLIN, Ph. D. 

Special Investigator, McLean Hospital, Waved y, Mass. 

T. MITCHELL PRUDDEN, M. D., LL. D. 

Author "Dust and Its Dangers " "The Story of the Bacteria," "Drink- 
ing Water and Ice Supplies," etc. 

FRANK CHOUTEAU BROWN 

Architect, Boston, Mass.; Author of "The Five Orders of Architec- 
ture," " Letters and Lettering." 

MRS. MELVIL DEWEY 

Secretary Lake Placid Conference on Home Economics. 

HELEN LOUISE JOHNSON 

Professor of Home Economics, James Millikan University, Decatur. 

FRANK W. ALLIN, M. D. 

Instructor Rush Medical College, University of Chicago. 



MANAGING EDITOR 

MAURICE LE BOSQUET, S. B. 

Director American School of Home Economics. 



BOARD OF TRUSTEES 

OF THE AMERICAN SCHOOL OF HOME ECONOMICS 



MRS. ARTHUR COURTENAY NEVJLLE 

President of the Board. 

MISS MARIA PARLOA 

Founder of the first Cooking School in Boston; Author of "Home 
Economics," "Young Housekeeper," U. S. Government Bulletins, etc. 

MRS. MARY HINMAN ABEL 

Co-worker in the "New England Kitchen," and the " Rumford Food 
Laboratory;" Author of U. S. Government Bulletins, "Practical 
Sanitary and Economic Cooking," etc. 

MISS ALICE RAVENHILL 

Special Commissioner sent by the British Government to report on the 
Schools of Home Economics in the United States; Fellow of the 
Royal Sanitary Institute, London. 

MRS. ELLEN M. HENROTIN 

Honorary President General Federation of Woman's Clubs. 

MRS. FREDERIC W. SCHOFF 

President National Congress of Mothers. 

MRS. LINDA HULL EARNED 

Past President National Household Economics Association ; Author 
of " Hostess of To-day." 

MRS. WALTER McNAB MILLER 

Chairman of the Pure Food Committee of the General Federation of 
Woman's Clubs. 

MRS. J. A. KIMBERLY 

Vice President of National Household Economics Association. 



MRS. JOHN HOODLESS 



Government Superintendent of Domestic Science for the province of 
Ontario; Founder Ontario Normal School of Domestic Science, now 
the MacDonald Institute. 



Home Care of the Sick 



BY 

AMY ELIZABETH POPE 

INSTRUCTOR IN TRAINED NURSING, PRESBYTERIAN 

HOSPITAL, NEW YORK CITY 

WITH PANAMA CANAL COMMISSION 




CHICAGO 

AMERICAN SCHOOL OF HOME ECONOMICS 

1907 






COPYRIGHT, 1904, BY 

AMERICAN SCHOOL OF HOUSEHOLD ECONOMICS 

COPYRIGHT, 1907, BY, 

HOME ECONOMICS ASSOCIATION 

Entered at Stationers Hall, London 
All Rights Reserved 



CONTENTS 



Letter to Students ..... 

Symptoms of Disease . . , . 

Choice, Furnishing, and Care of the Sick-Room 
Care of the Patient ..... 

Lifting and Handling the Patient 
Convalescence ....... 

Care of the Hair, Mouth, Teeth . 

Baths and Bathing ...... 

SiCK-RooM Methods ..... 

The Giving of Medicine . . . 

Purgative, Enemata, Douches, and Catheterization 

Poultices and Fomentations .... 

Contagion, Disinfection, Nursing in Contagious 
Diseases ...... 

Contagious. Diseases . . , 

Disinfection of the Room and Contents 
Surgical Ore-rations at Home . 
Obstetrics ...... 

Food for the Sick ..... 

Recipes ....... 

Emergencies; First Aid to the Tnjured . 
Foreign Bodies in Eye, Ear, Nose, Throat 
Poisons and Antidotes .... 

Bandages and Bandaging 
Bibliography . . . ... 

Preventable Diseases .... 

Consumption ...... 

Change of Climate in Consumption 
Pneumonia . . . . . . . 

Diphtheria ...... 

Typhoid Fever ...... 

Formaldehyde Disinfection — A New Process 

Program for Supplemental StiIjdy 

Index ....... 



V 
2 

9 
13 

2C 
29 
32 

34 
41 
48 

54 
59 

63 
67 

71 
73 
80 

93 

97 

105 

112 

113 
114 
122 

125 
126 

139 
141 

153 
165 
177 

183 
187 



AMERICAN SCHOOL OP HOME ECQNQMICd 
CHJCA©0 

January 1. 1907. 
Dear Uadam: 

Good ntirsing consists thief ly in 
being able to render certain assistance deftly 
and correctly and to derive the full benefit 
from this course you must, so far as practica- 
ble, try to carry out the instructions given in 
the lessons. 

Practice should not wait until you have a 
sick person on whom to experiment — ^your attempts 
might not be appreciated— but have someone "play 
patient" while you change the bed clothes, the 
gown, lift her up and down in bed, to another 
bed, to a chair, change the mattress, etc. 

Do all this not once but many times until 
you can follow out the directions softly and 
quickly. It would be best to do this before the 
answers to the tests are sent in, so that If 
there is anything in which you fail or that is 
not perfectly clear, you can ask for explanations. 



I regr©t that my new duties with the Panama 
Canal Commission will not permit me to look over 
your tests personally, but my substitute will, 
I know, give you all assistance needed. If I caii 
be of any further help, I shall be glad to have 
you write to me even though an exchange of letters 
takes some time. 

With best wishes for your success, I ani 
Sincerely yours. 

Supervisor 



HOME CARE OF THE SICK* 



TT IS the minority, not the majority of people, who 
^ can afford the luxury of a trained nurse, especially 
in cases of protracted and chronic illnesses. 

These lessons are intended to help those who cannot 
always command the services of a trained nurse, to 
teach how to carry out the doctor's orders, what to 
look for and observe in his absence, so that by giving 
him a definite report of what the patient's condition 
has been he may be able to work more understand- 
ingly, be able to diagnose the disease more quickly, 
be surer of how the patient is progressing, and of the 
influence the medicine ordered is having. And to 
teach above all how to handle and move patients with- 
out tiring them, how to render them comfortable, there- 
by ensuring rest of nerve and body. 

What to do in illness is purposely omitted in these 
lessons, except in very simple troubles and in cases of 
emergency. The ''what to do" is for the doctor to de- 
cide, the "how to do" for the mother to know. Incal- 
culable harm is continually being done by the latter 
encroaching on the doctor's prerogative. Many a 
mother has treated her child for supposed colic and 
only called the doctor in after some days when the 
pain has refused to yield to her treatment. In very 



Aims of 
the Lessons 



The Doctor's 
Province. 



HOME CARE OF THE SICK 



What 

the Mother 

Should 

Know 



many cases the treatment has been the worse thing 
possible for what has proved to be appendicitis, gastro- 
enteritis, or other serious abdominal trouble. 

There are few who can afford to run up the doctor's 
bill by calling him in unnecessarily. To avoid this, 
and yet not run the risk of endangering the lives of 
those entrusted to her care, especially the little chil- 
dren who cannot tell clearly where the pain is or how 
badly they feel, it is imperative that every mother 
should know how to count the pulse, take the tempera- 
ture, and be cognizant of at least a few of the primary 
symptoms of the most common diseases, especially the 
contagious ones, where the lack of early recognition 
and isolation may imperil the health or life of others. 

The following table gives the primary symptoms, 
period of incubation, and usual time required for iso- 
lation of the most common contagious diseases. The 
number of days between exposure to and the develop- 
ment of a disease is called the period of incubation. 



FIRST SYMPTOMS IN SOME OF THE MOST COMMON 
DISEASES 

CONTAGIOUS DISEASES 



DISEASE 



PERIOD OF 

INCUBATION 



SYMPTOMS 



Mumps Days 14-21 Swelling of the 

average 18 glands between 

ear and jaw, on 

either side or 

both. 



TIME OF 
ISOLATION 

From day when 
swelling first ap- 
pears till 10 days 
after, usually 3 
weeks. 



FIRST SYMPTOMS OF DISEASES 

CONTAGIOUS DISEASES (Continued) 



DISEASE 



PERIOb OF 
INCUBATION 



SYMPTOMS 



Chicken- Days 12-16 Slight fever, after 

pox average 14 24 hours small 

pimples appear 

on back and 

face. 



German Days 6-18 
Measles average 14 



Very slight fever, 
rash (if any) 
appears first on 
face, may only 
last a few hours. 
There may be 
headache and 



TIME OF 
ISOLATION 



From onset until 
last crust has 
fallen, usually 14 
days. 



From 2 days be- 
fore rash till 
symptoms are 
gone. S o m e - 
times 2 weeks. 



Measles 



Days 9-16 
average 12 



Small- 
pox 



Days 9-16 
average 16 



Sneezing, running 
from eyes and 
nose, face swol- 
len, sore throat, 
cough, f e V e r 
gradually rising, 
rash appears 
first on face and 
neck. 

Chill, rapidly ris- 
ing temperature, 
intense head- 
ache, pain in 
back and legs, 
rash, small, red, 
hard pimples, 
appearing first 
on face and 
wrists. 



From first ca- 
tarrhal s y m p - 
toms until des- 
quamation ceas- 
es, usually 24 
days. 



From onset until 
last crust has 
fallen, usually 6 
weeks. 



HOME CARE OF THE SICK 

CONTAGIOUS DISEASES (Continued) 



PERIOD OF 

INCUBATION 



TIME OF 
ISOLATION 



Scarlet- Days 1-7 
fever average 7 



From appearance 
of rash till des^- 
quamation has 
entirely ceased ; 
usually 6 weeks. 



SYMPTOMS 

Sudden vomiting, 
sometimes chill 
or convulsions, 
high tempera- 
ture, sore throat, 
tongue coated on 
edges, bright red 
in center, gener- 
al malaise, typ- 
ical rash appear- 
ing first on chest 
and shoulders. 

Especially in the 
beginning of the 
disease the tem- 
perature is, not 
as high as in 
tonsillitis ; head- 
ache, nausea, 
sore throat, with 
white patches on 
the tonsils. 



As it is sometimes difficult even for the physician to dis- 
tinguish between diphtheria and tonsillitis without taking a 
culture for examination, when white patches appear on a 
child's throat it should be isolated and a doctor called in 
at once. 



Diph- 
theria 



Days 1-6 
average 6 



From onset till 
germs have en- 
t i r e 1 y disap- 
peared. 



Children's 
Diseases 



DISEASES NOT CONTAGIOUS 

Colic. Give castor oil, then a few drops of pepper- 
mint in hot water (never soothing syrup) ; keep the 
baby warm and lying on his abdomen. Gentle rubbing 
in a circular direction, and the application of hot flan- 
nels will generally relieve it. If not, a physician 



FIRST SYMPTOMS OF DISEASES 5 

should be notified as continued abdominal pain is a 
symptom of many serious disorders. 

Cholera Infantum. Caused by over or improper 
feeding, heat and impure air. Symptoms : Diarrhoea 
and intestinal pain, excessive thirst, but no appetite. 
Try no home remedies, seek medical aid at once. 

Intestinal Obstruction. Symptoms : Obstinate con- 
stipation, followed by vomiting and abdominal disten- 
tion ; usually not much temperature. Get medical ad- 
vice promptly, as immediate operation may be im- 
perative. 

Convulsions. Caused by indigestion, worms, difficult 
dentition, or fright. Muscular twitchings coming on 
suddenly, ^sometimes even during sleep. Send for the 
doctor immediately, but do not await his arrival to put 
the baby in a hot bath. Give castor oil and an enema, 
according to directions given on page 55, using, if 
the child is small, a rubber catheter for a rectal tube. 

Pneumonia. Primary symptoms: Chill followed 
by high temperature, cough, pain in chest, expectora- 
tion which gradually becomes rust colored and bloody. 
Put patient to bed and send for the doctor imme- 
diately. 

Typlioid Fever. Primary symptoms : Temperature 
rising a little higher each day, nausea, headache, pain 
in back and limbs, nose bleed, sometimes constipation, 
sometimes diarrhoea, watery, yellow stools, abdominal 
pain. Put patient to bed and only allow liquid diet 
until the doctor comes. 



6 • HOME CARE OF THE SICK 

Meningitis. May develop suddenly with continuous 
convulsions, or come on gradually with symptoms of 
fretfulness, restlessness, headache, vomiting, and in- 
tolerance of light and noise. Put patient to bed in a 
quiet, dark, well-aired room and only allow liquid 
diet till the doctor comes. 

Croup. There are two forms of croup — the true or 
membranous and the false or spasmodic. The former 
is always associated with diphtheria, but since the use 
of antitoxine it has become a much rarer complication, 
seldom occurring when antitoxine is used. It comes 
on gradually. 
False Croup False croup comes on suddenly, generally in the 

middle of the night ; it is as a rule the result of ex- 
posure to damp and cold, excitement, or indigestion. 

The spasm is the result of the spasmodic closing of 
the glottis. Though not dangerous, it is very distress- 
ing and calls for immediate treatment. Relief usually 
can be obtained best by applying hot fomentations to 
the throat, inducing vomiting by giving a drink of 
tepid water and salt — a teaspoonful to the glass — and 
by steam inhalations. 

The most effective way of giving inhalations is with 
the croup kettle and canopy. The quickest way to im- 
provise these is to tie an umbrella to the top of the 
child's crib and over this drape two sheets, pinning 
them to the sides of the bed. They must overlap 
about one inch and hang down far enough over the 
sides and back of the bed to be tucked under the mat- 



DISEASES 7 

tress. The lower third of the front space is left open 
for the admission of fresh air. Water is kept boiling 
in a kettle at the back of the bed by a gas or oil stove 




Canopy for Giving Steam Inhalations Made with a Sheet 
and Umbrella 



and a cone of cardboard or stiff paper is attached to 
the spout and inserted between the overhanging sheets 
to carry the steam over the child's head. 



8 HOME CARE OF THE SICK 

Minor In nearly all cases of slight indisposition, even 

Troubles cUarrhoea, a cathartic such as castor oil or calomel, fol- 
lowed by salts such as Rochelle salts, magnesium sul- 




Rear View of Croup Canopy Showing Stove, Kettle, and Tube 
for Steam 

phate, or seidlitz powder, five or six hours later, to- 
gether with rest and fluid or soft diet is indicated. 
Give as little medicine as possible without a doctor's 
order. 



THE CHOICE, FURNISHING AND CARE OF THE SICK> 
ROOM 

Sunshine, pure fresh air, and freedom from noise 
and odors are the principal things to be, considered in 
choosing the sick-room. When possible it is advisa- 
ble to have a room with a southern exposure. If there 
is a fireplace or grate in the room so much the better, 
as a chimney is an excellent medium for ventilation. 

Despite the fact that the sick-room at the top of 
the house gives many stairs to climb, it is better to 
have it there. It is further removed from the noises 
of the street and house and the air is generally purer. 

Only necessary articles of furniture should be re- 
tained; all heavy hangings, draperies, and upholstered 
furniture must be removed. Care must be taken, how- 
ever, that the room is not made too bare and unat- 
tractive. Short, washable curtains ; clean, white linen 
covers for the tables ; a few fresh flowers will help 
to make the sick-room bright and cheerful. Flowers 
should be removed at night, the water they are in 
changed daily, and they should never be tolerated after 
they begin to fade. 

The ideal bed is iron or brass ; single or three- 
quarter width. The double bed is unadvisable, for 
owing to its width, the mattress is apt to sink in the 
middle and it is then almost impossible to keep the 
under sheets drawn tightly enough to prevent wrinkles. 
The bed should be at least twenty-five inches in 



Furnishings 



The Bed 



HOME CARE OF THE SICK 



The 
Mattress 



Lighting 



height, but if it is not, can easily be made so by plac- 
ing heavy blocks of wood under each leg. Hollows 
about two inches in depth should be made in the 
blocks to fit the ends of the. legs. Especially if the 
patient is liable to be ill long, the trouble of doing this 
is well repaid by the added convenience in lifting and 
working over the patient. 

A hair mattress is by far the best kind to have ; the 
feather one the worst. Not only is the latter too heat- 
ing, but when occupied it is almost impossible to make 
the bed properly. 

The bed should be placed far enough from the walls 
to give access on alb sides, care being taken to avoid 
having the light in the patient's eyes. 

The best plan is to have the window behind the 
bed ; then more sun and light can be admitted without 
disturbing the patient. Except in certain cases, it is 
a mistake to keep the sick-room darkened. 

Besides the bed, there should be two or three chairs 
in the room ; one a comfortable arm chair with high 
back. If upholstered, it should be encased in a pretty, 
light, washable cover. Rocking chairs should never 
be permitted in the sick-room ; when sitting in them 
one is almost sure to rock, and the motion is very 
apt to irritate the patient. 

Two tables are necessary ; on one should be kept 
writing material, where the doctor can write his orders 
and the nurse keep the record of the patient's condi- 



Table 



THE SICK ROOM " ii 

tion. The second table can be near the bedside to hold 
the patient's bell ; also her food-tray ; the latter must 
always be removed as soon as the meal is finished. 
Never leave empty or half empty glasses of milk, cups 
of broth, etc., standing by the patient. 

There is a bedside table — made on purpose for use Bedside 
in the sick-room — which is very convenient. The top 
extends over the bed in front of the patient; it is ad- 
justable and has a foot piece which goes under the 
bed and keeps the table from upsetting. (See page 30.) 

Medicine bottles and all necessary utensils should 
be kept in an adjoining room, if possible. 

The floor should be swept with a soft broom cov- 
ered with cheese cloth, or other soft material which 
is free from lint. Carpets are very objectionable; 
small rugs which can be removed and shaken daily, 
being preferable. If the carpet must remain, see that 
it is kept well dusted, and that no dust is raised while 
doing so. The best way to do this to to sweep with 
a damp broom, going over it afterwards with a damp 
cloth pinned over the broom. Do not have this too wet 
or it will injure the carpet. 

When it is necessary for the nurse to sleep in the 
room, the cot is the most convenient arrangement, as 
it is comfortable, inexpensive and can be easily re- 
moved in the day time. 

Never use a feather duster but clean, soft dust cloths 
which may be washed out every day. Except for the 



Dusting 



12 HOME CARE OF THE SICK 

varnished furniture, it is better to have the duster 
shghtly damp, as this will prevent scattering of the 
dust.. 
Ventilation The air in the sick-room must be as pure as the air 

outside. The value of fresh air as an aid to recovery 
is sadly underrated. The open fireplace is one of the 
best methods of ventilation. A current of air can be 
created in summer by placing a lamp or a candle in 
the chimney place, and in winter a wood or a coal fire. 
Next to a fireplace, an open stove gives the best means 
of ventilation. 

Window ventilation is best obtained by double win- 
dows with double sashes. The lower sash of the outer 
window is raised about two feet; the upper sash of 
the inner window lowered about the same distance. 
The passage of air being thus directed upward, a di- 
rect draught upon the patient will not be produced, if 
windows and doors on the opposite side of the room 
are kept closed. Where there are single windows, the 
same effect can be obtained by tacking the lower end 
of a piece of cotton, about twelve inches in depth, to 
the frame of the upper sash and to the top of the win- 
dow frame ; then lower the sash about ten inches. 
When less air is desired the lower sash can be raised 
and a board fitted to the opening; the air then passes 
upward between the sashes. 

In addition to this slight continuous ventilation, the 
window must be opened and the entire air of the sick- 
room changed at least twice a day. In doing this, be 



Airingr 



Fuel 



CARE OF THE PATIENT 13 

careful that there is no draught and that the patient 
has extra blankets. If there is no screen at hand, a 
large umbrella will prove quite effective in protecting 
the patient's head from the direct current of' air. If 
it is necessary to warm the air before it enters the 
patient's room, the window in an adjoining, well-heat- 
ed room may be opened, the door between the rooms 
being left slightly ajar. The corridor or bath room 
(especially the bath room) should not be used for 
this purpose. 

Hard coal should be used if the room is heated by 
a stove on account of its freedom from dust. Ashes 

In removing the ashes, they should be sprinkled with 
water first to prevent flying, then quietly shoveled up. 
The coal can be added in paper bags filled outside, 
thus avoiding all noise likely to disturb the patient. 

The temperature of the sick-room should be 68 de- 
grees F at night and 70 degrees F during the day. 

CARE OF THE PATIENT 

A few essential points to be remembered in caring 
for the sick may be stated briefly. 

To properly care for a patient those undertaking the ^^^^ ^^ 
responsibility of the nursing must take proper care of *^® Nurse 
themselves. Rest, recreation, and out of door exer- 
cise are positive necessities. 

If the same member of the family has both day and 
night nursing to do she should always dress herself 
as comfortably as possible for the night. A cold bath 



14 



HOME CARE OF THE SICK 



in the morning, with complete change of clothing, will 
be found very refreshing. 

Dresses of light wash material should always be 
worn when attending the sick, but dresses and skirts 
must never be stiffly starched, as the rustling noise 
they make is very annoying to patients. Squeaking 
shoes are another abomination. 
"Nevers" Never whisper in or near the sick-room. 

Never discuss the patient's condition with her, or 
with anyone else in her hearing. 

Never tell the patient what her temperature, pulse, 
etc., are, not even when they are normal. 

Never tell the patient what medication you are giv- 
ing her. 

Never lean nor sit on the patient's bed, and be care- 
ful not to knock against it in passing. 

When speaking to a patient always stand in front 
of her, where she can see you ; be particularly careful 
not to speak to her suddenly from behind, for when 
people are ill and nervous they are easily startled. 

Keep door and window hinges well oiled ; nothing is 
more aggravating than a squeaking door. 

When windows rattle, wedge them apart between the 
sashes with pieces of wood or newspaper. 
At Night Especially at night, or, rather, when getting ready 

for the night, attention must be paid to anything likely 
to prove a disturbing element to the patient's rest. 

Before the patient goes to sleep see that you have 
everything at hand that you are likely to need for the 



"When 
Speaking 



CARE OF THE PATIENT 



15 



night : Extra blankets — a shade for the light, if neces- 
sary — coal prepared in paper bags, as previously de- 
scribed — milk — water — all the medicines you will re- 
quire — ice, etc. Wrapping the ice in flaimel or news- 
paper will keep it from melting. A hat pin makes an 
excellent and noiseless ice-pick. A large tin pan, en- 
veloped in a blanket, will make a serviceable refriger- 
ator in which to keep your ice, broth, milk and water. 

A shade for the lamp or gas can be easily made out 
of green or other dark colored cambric, but be sure 
that the globe over which it is pinned is far enough 
from the flame to avoid scorching the cambric. 

An uncomfortable bed is a great addition to the mis- 
eries of an invalid, therefore, one of the first essentials 
to be learned is how to make a bed. 

The mattress is covered by a sheet, stretched tightly 
and tucked firmly as far under it as possible; folding 
the corners like an envelope helps to keep it firm. 

Another sheet called the ''draw sheet" is also used 
under the patient ; this is put on with the length across 
the bed, thus allowing a considerable fold under the 
mattress, thereby securing a further means of keep- 
ing the sheet tight. When putting the draw sheet on 
care must be taken to have it perfectly straight; it is 
first tucked in on one side, well under the mattress. 
In tucking in the second side it is best to begin in the 
middle, going first towards the bottom, then from 
the middle to the top, pulling it very tightly. The top 
sheet and blankets (single blankets are preferable to 



Bed 
Making 



The 

Draw Sheet 



i6 HOME CARE OF THE SICK 

double) should be put on separately, the corners being 
folded in, in the same manner as the under sheet. If 
it is not convenient to obtain a spread of dimity, or 
other light material, it is better to use a sheet, as the 
ordinary spread is heavy and gives comparatively lit- 
tle warmth. 
Protecting When it is necessarv to protect the mattress a rub- 

ber sheet is placed between the lower and draw sheets. 
White double faced rubber is the nicest for home use. 
The single faced rubber will answer the purpose and 
is cheaper, but it is not so easily kept clean. Either 
can be obtained at any rubber store. 

When impossible to get the regular rubber sheet- 
ing thin oil cloth, such as is used for covering tables, 
will serve. In cases of emergency, several thicknesses 
of newspapers may be used until something better can 
be obtained. 

CHANGING THE BED OF A HELPLESS PATIENT 

Before starting to change the bedding be sure that 
you have everything necessary near at hand, and that 
the bed clothes are all well aired, perfectly dry and 
'warm. 

First take off the spread, fold it neatly; next take 
off the top blanket, and hang it out to air. Fold the 
other blanket and upper sheet over the patient, leav- 
ing the ends just long enough to cover her when you 
turn her over. This method answers a threefold pur- 
pose: (i) it has a neat appearance; (2) it replaces the 




CHANGING TBI. UiLVW SHEET 



Changing 



i8 HOME CARE OF THE SICK 

discarded blanket, and (3) the clothes are not in the 
way while you work. Loosen the lower sheets by rais- 
ing the mattress with one hand while drawing out the 
sheets with the other. Raising the mattress is impor- 
tant, because the draw sheet has been tucked so far 
under the mattress that otherwise you risk not only 
jolting the patient but also tearing the sheets. Re- 
move the pillows and if the patient does not object 
to lying flat for a while leave them out; if she does, 
one can be replaced. It is necessary to take them out 
to turn them and to make sure that there are no crumbs 
caught between them or in the pillow cases. 

The night gown is the next thing changed. Have 
Ni lit Gown ^^^ patient lie on her back and flex her knees ; if she 
is well enough she can easily raise herself while in this 
position ; if not, place one hand under the buttocks 
and raise her, as you draw the gown up with the other 
hand, then raise the shoulders in like manner, drawing 
the gown up over them and the head before taking 
out the arms. 

In putting on the clean gown roll the skirt up, and 
put the patient's head through the hole. Putting your 
hand through one sleeve grasp the patient's hand and 
draw it through ; then do likewise with the other sleeve. 
The gown is then pulled down in the same manner as 
the soiled one was taken off. 

The easiest way to change the under sheets is first 
to turn the patient on her side. 

To do this, stand on the side towards which you will 



CHANGING THE BED 



19 



turn her, slip one hand over and under her, with your 
arm sHghtly crooked, so that the hand and forearm 
will support and control one shoulder, the elbow sup- 
port the back of the head, and the arm the other shoul- 
der. Slip your other arm under the patient slantwise 
across the buttocks, so that the hand is under the 
small of the back. In this v/ay the patient is well sup- 
ported as you gently turn her towards you. If there 
is an assistant, one can hold her thus while the other 
manipulates the sheets ; if not, and the patient needs 
to be supported, a pillow placed well up against her 
back will answer the purpose. 

The sheets to be changed are folded close to the 
back of the patient, making the fold as flat as pos- 
sible. The clean sheet is either folded fan shape or 
rolled to its centre, the roll or fold, as the case may 
be, is placed close to the sheet being removed, the 
loose edge is tucked in, as far under the mattress 
as possible, the patient is then rolled gently over on 
to the clean sheet, the soiled one removed, and the clean 
sheet v/ell stretched, and tucked in according to the 
directions given in the making of the bed. 

The top sheet is next changed. Placing the clean 
sheet over the sheet and blanket which are still over 
the patient ; on top of this put the blanket which has 
been airing, draw the other blanket and sheet from 
underneath, then tuck in the clean ones, put on the 
second blanket, if one is necessary, then the spread, 
and arrange the pillows. 



Turning 

the 

Patient 



Changing 

the 

Draw Sheet 



Changing 

the 

Top Sheet 



20 HOME CARE OF THE SICK 

The draw sheet, upper sheet, and night gown should 
be changed twice a day when the patient is not too 
ill ; if ' they are not soiled when removed, air them 
well, after which they may be used again. 

When the patient is not allowed to be bathed, her 
back should be washed with soap and warm water, 
rubbed .with alcohol and powdered with talcum pow- 
der. This should be done while she is turned on her 
side for the changing of the sheet. When the night 
gown is closed in the back it is sometimes more con- 
venient not to put the clean gown on until the pa- 
tient's back has been washed. In such circumstances 
wrap a small shawl around the patient. 
special When for any reason it is inadvisable to move the 

patient, and it is necessary for her to lie on her back, 
it is convenient to have short gowns, open in the 
back, buttoned at the back of the neck and shoulders. 
The skirts can be drawn from under the patient, enab- 
ling her to lie on the sheet, which it is comparatively 
easy to keep free from wrinkles. Another important 
advantage of the short gown is the ease with which it 
can be changed. Large collars or ruffles at the neck 
of the gown are very objectionable in illness. 

When changing the gown of a patient whose arm is 
disabled, the sleeve should be taken from the affected 
arm last, and the sleeve of the fresh gown put on first. 

LIFTING AND HANDLING THE PATIENT 

When lifting a patient it is important to stand 
firmly ; to do this the feet should be placed well apart, 



' LIFTING THE PATIENT 21 

bracing one foot against the leg of the bed. Try to 
bend the back as Httle as possible, make the knees 
do the bending. In lifting, endeavor to have the 
weight come on your shoulders, not on your back. For 
example, when a patient is to be helped into a sitting 
position, bend your knees till your shoulder is only 




A BACK REST, CANVAS COVERED. 

slightly higher than the patient's, then have her put her 
arm across your shoulders, have your shoulder di- 
rectly under her armpit, your elbow supporting her 
head, your hand under her other armpit — your other 
hand is thus free to arrange the pillows. Now raise 
the patient. By using this method your shoulder 
bears the burden, whereas if you attempt to raise the 
patient by bending your back, or if you have the pa- 
tient's arm around your neck, the entire weight must 



Back Rest 



22 HOME CARE OF THE SICK 

be sustained by your back, which will soon become 
strained. 
The A back rest should always be provided when the 

patient sits up in bed for the first time. Many varieties 
of these are to be had, and they are inexpensive ; some 
are made entirely of wood, others have a wooden 
framework with canvas stretched across it. A good 
substitute for the back rest is a straight back chair 
turned upside down. The pillows should be placed 
across the rest in such a way that the head will not 
be thrown forward and that the small of the back will 
be well supported. 

When the patient is obliged to sit up all, or nearly 
all the time, something should be provided for her 
to brace her feet against. A convenient arrangement 
for this purpose is a board the same length as the 
width of the bed and about twelve inches wide, placed 
between double folds of strong muslin which must be 
long enough to tie around the head of the bed when 
the board is supporting the patient's feet. The board 
may be padded on one side if desired. 
Change of When a patient has slipped down in bed and needs 

to be drawn up, place one arm under the shoulders 
in the usual crooked position so that your elbow may 
support her head, and taking a firm grip under the up- 
per, part of her arm, put your other arm under the 
thighs, and move the patient gently upwards. If well 
enough the patient can flex her knees and help in the 
movement. 



Position 



HANDLING THE PATIENT 



23 



If a patient is so heavy that two persons are re- 
quired to move her, they should stand on opposite sides 
of the bed and reaching across the patient's back firmly 
g-rasp her under the armpits, their crossed arms thus 
forming a \^-shaped rest for her head while they clasp 
each other's hands under her thighs. 

When the patient is well enough to help herself, put- 
ting a stout, broad piece of muslin round the foot of 
the bed with the ends long enough to be grasped, will 
help her to assume a sitting position ; one round the top 
of the bed will help her to pull herself up higher in 
bed. - 

If necessary to change your charge from one bed 
to another, place the beds about five feet apart, parallel 
with each other, with the head of one on a line with 
the foot of the other. Unless the patient is very light 
there should be two to lift, both standing on the same 
side (between the beds). One puts her arms under 
the shoulders and buttocks, the other under the back 
and thighs. If possible have the patient hold herself 
stifif. Lift her gently in unison, turn round and place 
her on the fresh bed. 

If the patient is heavy three may be required to do 
this well. Under these circumstances the first lifter 
supports the head and small of the back, the second 
the shoulders and thighs, the third the buttocks and 
under the knees. 

When the lighting of the room or other considera- 
tions render it unadvisable to change the position of 



Changing 
the Patient 
from One Bed 
to Another 



CHANGING THE MATTRESS 25 

the head of the bed, they are placed near together with 
the heads on a hne. The patient is hfted from the far 
side of the first bed, carried around between the two, 
and laid down in the second bed. This entails a 
longer carry, but if all work in unison it is not dif- 
ficult. 

TO CHANGE THE MATTRESS "WITH THE 
PATIENT IN BED 

To the uninitiated this seems an almost impossible 
feat. In reality, if done according to rule, it is not 
much harder than changing the under sheets. If the 
patient is heavy four people will be required to ac- 
complish this deftly, two on either side of the bed. 
The sheets are loosened on all sides ; the top sheets 
and the blankets treated in the same manner as when 
the bed clothes were changed ; the under sheets are 
rolled tightly up to the patient's side (the roll being 
undermost). Using these rolls for support, the patient 
is moved to one side of the mattress ; this side is then 
pulled to the centre of the bed, curving the mattress 
upwards; the fresh mattress is placed alongside, the 
patient lifted by the bed-clothes on to it, the dis- 
carded mattress removed, the fresh one drawn into 
place, and the patient lifted to the centre ; the sheets 
are again unrolled and tucked in place. 

THE PREVENTION AND CURE OF BED SORES 

A bed sore is gangrene, or death of the tissue of 
the affected parts. The bony prominences such as the 
lower part of the spine, the shoulder blades, elbows, 



BED SORES 



27 



and heels are the parts most Hkely to be affected. 
Moisture, wrinkles, crumbs, and a too long continu- 
ance in one position are the pre-disposing causes, 
therefore these conditions must all be guarded against. 

The presence of moisture is generally due to per- 
spiration, or discharge from wound, bowels or blad- 
der. When the two latter are the 'causes pads made 
of oakum or jute placed in cheese-cloth or old muslin, 
put on the patient like a child's diaper, will save the 
bed linen. These must be changed as often as neces- 
sary, and the patient well washed with warm water 
and soap ; dusting with a little talcum, starch, or rice 
powder will help to keep the skin dry and soft and it 
will also prevent chapping. Crumbs and wrinkles 
must also be guarded against. By keeping the draw 
sheet tightly drawn and tucked far under the mattress 
the latter will be overcome ; the former must be looked 
for after every meal ; brushing them out with the hand 
is the most efficient way, but a small whisk-broom may 
be used. 

At least twice a day all parts likely to be affected, 
especially the back, should be washed with warm water 
and soap, rubbed with 50 per cent alcohol, and dusted 
with talcum. This not only helps to prevent bed- 
sores but is unspeakably refreshing to the weary in- 
valid. Avoid using too much powder or it will cake 
and do more harm than good. 

A preparation of equal parts collodion and castor 
oil painted over the surface will often prevent a break- 
down of the tissue, by forming an artificial skin. 



Avoid 
Moisture 



Artificial 
Skin 



28 



HOME CARE OF THE SICK 



Relieving 
Pressure 



Care of 
a Sore 



Frequent change of position is another important 
means in the prevention of bed-sores. Prop the pa- 
tient over on her side by putting a couple of pillows 
lengthwise behind her, one under her shoulders, the 
other under the lower part of her back. Rings made 
of batting or sheet wadding wound with bandages are 
excellent mediums for relieving pressure. They should 

be made with the hole just 
large enough to permit of 
the bony prominence fitting 
into it. When the patient 
has to lie for some time on 
her back, often consider- 
able relief is given by flex- 
ing the knees. They can be 
supported either by a pillow 
doubled and tied to hold it 
so (the pointed side placed 
next the body), or a cylin- 
drical pillow made like the old-fashioned bolster, only 
smaller and stuffed with hair. Small pillows or hot 
water bags filled with cool water, placed under the 
small of the back, will help to make a long continu- 
ance of the dorsal position bearable. 

All pillows should be shaken and turned frequently. 
If the skin should become broken, the resulting sore 
should be washed daily with bichloride of mercury 
I-2000, and a dressing applied. Gauze soaked in 
balsam of Peru or an ointment made of castor oil and 
zinc oxide powder are generally found efficacious. 




Wadding Ring, 
to Relieve Pressure 



CONVALESCENCE 



The most anxious moments in nursing are certainly 
when the disease is at its height, but by far the most 
trying are, as a rule, during the time of convalescence. 
It is then that the greatest exercise of tact, discern- 
ment, self-control and patience on the part of the at- 
tendant are necessary. 

Relapse, except in the 
germ diseases, is nearly al- 
ways due to over- feeding, 
over-exertion, or nervous 
excitement. 

The diet is a very impor- 
tant factor in the treatment 
of convalescents. Carry out 
the doctor's orders minute- 
ly regarding it. Have, so 
far as you can, things that 
you know the patient likes. If she expresses a prefer- 
ence for a certain dish have it if allowable, but as a 
rule it is not wise to consult her on the subject. 

Always serve your patient's meals as daintily as pos- 
sible ; have the tray covered with a spotless table nap- 
kin or tray cover; use the prettiest china available; 
even one bright flower with a little green is a great 
attraction. But above all see that the food is properly 
cooked and properly served ; that all hot things are 
very hot, and cold ones really cold. More salt and 
less sugar will generally be wanted than when in 

29 




Rubber Air Cushion 



Serving 
of Meals 



30 HOME CARE OF THE SICK 

health. Highly seasoned food is not advisable or often 
desired even by those who like it when well. 

It is better to set before the invalid too little than 
too much, for it is easy to get more, and the sight of 
too much food on the tray is apt to imbue anyone 




A Bedside Table Convenient for Serving Meals 

whose appetite is poor with a dislike for it. Besides, 
as the digestive functions are weakened during and 
after illness, it is better for a time to serve food in 
smaller quantities and oftener; for instance, give an 
egg nog, milk punch, egg lemonade, egg albumen, or 
other light, easily digested drink between breakfast 



CONVALESCENCE 



31 



and the noonday meal, and again at three or four 
o'clock in the afternoon. A glass of hot milk given at 
bed-time will often induce sleep. 

Keeping the patient amused is another important 
item in the care of the convalescent. A few visitors 
(provided they do not stay too long, talk too much, 
or give any worrying or disagreeable news) will of- 
ten help to brighten up the patient. Playing cards or 
games, reading aloud to her, etc., will help to pass 
away the time and tire her less than talking. 

When people have been ill for some time the muscles 
of the eyes are apt to be weak and will be easily 
strained, so they ought not to be allowed to read much 
themselves, especially while they are in the recum- 
bent position. 

Those who are strong and well little realize the ex- 
ertion and excitement caused by the first sitting up, 
after being confined to the bed for some time. 

The period is usually limited to half an hour the 
first day, gradually increasing the time as the patient 
can stand it. Do not wait for her to complain of 
fatigue ; on showing the first signs of it she should 
be put to bed. Of course there are patients who think 
themselves a great deal worse than they really are, 
and who have to be encouraged to sit up longer than . 
they think they can. At such times the pulse is a 
good guide. 

Do not really dress the patient until she is well 
enough to walk around. Warm stockings, bed slip- 



Amusing 

the Patient 



Sitting Up 
for the 
First Time 



32 HOME CARE OF THE SICK 

pers, a warm wrapper and blankets are all that are 
necessary. 
Lifting If the patient has been seriously ill she should not 

a Chair be allowed to stand or exert herself in the least when 
sitting up the first few times. If not too heavy she 
can be lifted by one person. The arms of the patient 
are locked about the neck of the attendant, who, plac- 
ing one arm under the thigh, the other under the back, 
lifts the patient into the chair, the back of which is 
parallel with the foot of the bed. 

When two people are required to do the lifting they 
should stand at the same side of the bed, placing the 
hands, one under the shoulders and buttocks, the 
other under the thighs and ankles, and lifting in uni- 
son, turn and seat the patient gently in the chair. The 
chair should be made comfortable with pillows, and 
the patient kept warm with blankets. When possible 
the chair should be carried carefully into an adjoining, 
well-aired room. The sick-room and bed should be 
well aired and made ready immediately for the patient's 
return, as it may be necessary for her to be put back 
to bed sooner than expected. 

CAHE OF THE HAIR, MOUTH, TEETH 

While caring for the hair protect the pillow-case 
with a towel. When the hair is tangled always hold 
it between the tangle and the head to avoid pulling it. 
Rubbing a little vaseline into the scalp will help to 
get the snarls out more easily. To avoid tangles the 



CARE OF THE HAIR, MOUTH, TEETH 



ZZ 



hair should be brushed twice daily and braided in two 
plaits. 

If the scalp is kept clean by rubbing it occasionally 
with a little alcohol and water (equal parts) the hair 
always well brushed, and rubbed once in a while be- 
tween a damp wash-rag, it may not be necessary to 
wash it for quite a while. 

When it must be washed, protect the pillow and 
upper part of the bed with a rubber sheet covered 
with a bath towel. Pull the pillows down under the 
back so that the head extends somewhat beyond them 
and over a basin of water. Have a slop jar at hand 
in which to empty the water, and plenty of warm 
water to wash the soap out thoroughly. Support the 
head with one hand while you wash it. Dry the hair 
well after washing. A little alcohol or hair tonic con- 
taining it, well rubbed into the scalp, will lessen the 
chance of the patient taking cold. 

When the patient is unable to brush her own teeth 
it is often easier to do it for her with clean gauze 
wrapped around the index finger or the end of a piece 
of whalebone, than with a tooth-brush. In illness 
sordes (tartar) is apt to collect between the teeth un- 
less they are very frequently and carefully cleansed. 

Clean not only the teeth but also the gums, the roof 
of the mouth and the tongue. Whalebone and gauze 
are far better for this purpose than the brush. W^hen 
a patient is on milk diet her tongue and mouth should 
be cleansed after each feeding. 



Washing 
the Hair 



Care 
of the 
Teeth 



Care 
of the 
Mouth 



34 HOME CARE OF THE SICK 

Some good mouth washes are : 

(i) Equal parts of listerine, boric acid 4 per cent, 
lemon juice and water. 

(2) Listerine, one ounce; peroxide of hydrogen, 
three drachms ; alboline, one drachm. 

(3) Tincture of myrrh, half a drachm; soda bi- 
carbonate, grains twenty ; aboline, one drachm. 

(4) Listerine and water, equal parts. 

BATHS AND BATHING 

Perhaps there is nothing that will give greater re- 
freshment to the invalid, obliged to lie in bed day 
after day, than a bath. Unless contrary to the physi- 
cian's orders, one should be given every day. If given 
in a warm room, without exposure, there is absolutely 
no danger of the patient taking cold. To make mat- 
ters doubly sure, before taking out of the bath blank- 
ets, rub the patient all over with 50 per cent alcohol. 
The Never give a bath until an hour after a meal. Be- 

*^^atl foi'e beginning see that the room is not only warm but 
free from draughts, also that you have everything 
needed at hand. It is best to have the water in a foot 
tub ; it will keep warm longer than in a shallow basin. 
Have a pitcher of hot water to keep the bath the re- 
quired temperature. 

A large blanket, face and bath towels, wash cloths, 
alcohol and powder are the other necessary articles. 
Slip the blanket under the patient. If it is not wide 
enough to come well round her and also for the ends 



BATHS AND BATHING 35 

to overlap, use two. The blanket may be covered by 
a sheet if necessary but the wool next the body is de- 
sirable. 

Take off the night-gown and fold down the upper 
bed clothes — the face and neck are washed first and 
well dried, then the arms and hands. Be particular 
about drying between the fingers, also around and in- 
side the ears. Especially while washing the face have 
a firm touch. Expose only one portion of the body 
at a time, and that not longer than necessary. Dry 
each part well before going on to the next; in order 
not to fatigue the patient, work as quickly as possible. 
It should be necessary to turn her only once. The 
towels should be warmed by wrapping them around a 
hot water bottle. It is well to give hot broth or milk 
soon after the bath. 

To give a foot bath, loosen the bed clothes at the 
bottom, protect the bed with a blanket, put the foot Foot Bath 
tub, half full of water lengthwise on the bed, flex 
the patient's knees, raise her feet with one hand while 
you draw the tub under them with the other; wrap 
a blanket round tub and knees. 

When mustard is desired, make a paste of the 
mustard — about two tablespoonsful to a large foot 
tub. The feet remain in about twenty minutes, the 
bath being kept at the same temperature by the addi- 
tion of hot water from time to time. Be careful in 
adding the hot water not to pour it in near the feet. 



The 



36 



HOME CARE OF THE SICK 



Baths for 
Reduction of 
Temperature 



"Brand" 
Treatment 



When the bath is over wrap the feet in the blanket for 
a few minutes, then dry. 

To give a bath for the reduction of temperature a 
large rubber (covered with a sheet) is necessary to 
protect the bed, as a considerable amount of water must 
be used. 

There are several different kinds of bed baths given 
for this purpose. Sometimes the patient is simply 
sponged off with cold water, at others a hot sponge 
comes first, followed by the cold which often consists 
of equal parts of alcohol and water, made colder at 
times by the addition of ice. The doctor always orders 
the temperature of the bath, and also the duration, 
which is generally from ten to twenty minutes. 

In giving these baths, use slow, long, curving, down- 
ward strokes, and plenty of water. Where there is a 
high temperature there is no danger of catching cold, 
and as eradiation of heat is the effect sought, the pa- 
tient should be exposed as much as possible. It is 
often desirable, when the sponging is over, to rub the 
patient with alcohol, and fan till dry. 

When possible, the "Brand" treatment is used for 
the reduction of temperature (especially in typhoid). 
For this, a portable tub, which can be wheeled to the 
bedside, is required. It would not be safe to give such 
a bath without the assistance of a doctor or trained 
nurse; it is, therefore, not worth while going into de- 
tails, and, except in cases of long continued fever, 
the bed bath is generally all that is necessary. 



BATHS AND BATHING 



37 



When given a hot bath in a tub, fill the tub three- 
fourths full of water ; the exact temperature will be 
ordered by the doctor, usually it is from io6 degrees 
F to no degrees F. The doctor also states how long 
he wishes the patient to remain in the bath. When 
giving a hot bath of any kind, for any purpose, al- 
ways apply cold cloths or an ice cap to the head. A 
hot drink given either while the patient is in the tub 



Hot Baths 
to Induce 
Perspiration, 
or Quiet 
the Nerves 




BATH THERMOMETER 

or after the return to bed will further induce perspira- 
tion. Mustard is sometimes added to these baths, just 
as it is to the foot bath. 

While in the tub the patient's pulse must be noted 
carefully, as such baths are sometimes very depressing 
to the heart. After the bath the patient must go to 
bed immediately, and remain there well covered, and 
care must be taken to have warm clothing going from 
the bath to the bed. These baths are also given to 
children in convulsions. 

The hot-pack, or sweat, is generally considered a bet- 
ter medium for inducing perspiration. To give this 
protect the bed with a rubber sheet or oil cloth, wring 
out two old blankets in water 130 degrees F, put one 
under the patient and around one arm and leg, the 



Precautions 



The Hot-pack 
or Sweat 



38 ' HOME CARE OF THE SICK 

other over the patient and around the other arm and 







GIVING A HOT-PACK 



leg; put an ice cap or cold compress on the head, a 
hot water bag at the feet, another over the heart, 




HOT-PACK COMPLETED 



others along the side, over all wrap a couple of dry 
blankets ; give a hot drink. The patient generally re- 



BATHS AND BATHING 39 

mains in the pack from twenty minutes to half an hour. 
The pulse should be taken every five minutes, and as 




HOT V^ATER BOTTLES 



the hands are under the blankets it must be taken at 
the temporal artery. 




HOT WATER BOTTLE FOR THE SPINE 

After being taken out of the pack the patient should 
be rolled in a dry blanket and remain so for an hour. 



40 



HOME CARE OF THE SICK 



Salt Baths 




Water Bottle for the Throat 



Except where a light weight is desirable, as over 
the heart and abdomen, a good substitute for the rub- 
ber hot water bag is a stone bottle ; even a glass one can 
be used, and if a wire a couple of inches longer than 

the bottle is put into it 
to act as a heat con- 
ductor, it can be filled 
with quite hot water 
without breaking. When 
using hot water bags or 
bottles of any kind, pre- 
cautions must be taken 
to avoid burning the 
patient, which is very easily done, especially with old 
people, or where from any cause, the circulation of the 
blood is sluggish or the tissues in poor condition; 
therefore, see that the bottles are tightly corked, that 
they are well and securely covered (flannel bags slight- 
ly larger than the bottles make the best covering) ; 
never put them too near the patient, and remember that 
when the patient is restless the bags arc apt to slip 
nearer than you intended them to be. 

Salt baths are given for their tonic effects. A bath 
sufficiently strong to redden the skin and have an ex- 
hilarating effect will require ten pounds of ordinary 
sea salt to a bath tub about half full of water. 

The average standard temperature for baths is as 
follows : 



Clinical 



SICK ROOM METHODS 41 

Cold 33°-65° Fahr. Tepid.85°- 92° Fahr. 

Cool 67°-75° Fahr. Warm92°- 98° Fahr. 

Temperate. 75°-85° Fahr. Hot. .98°-ii2° Fahr. 

The regular bath thermometer is encased in wood 
to protect it from hard usage, but the ordinary atmo- 
spheric thermometer will answer the purpose just as 
well. Mix the water well before taking the temper- 
ature. 

SICK ROOM METHODS 

Taking and Recording Temperature, Pulse and Respiration 
Observation and Recording of Symptoms 

The heat of the blood is ascertained by means of the 
clinical thermometer. These thermometers are self Thermometer 
registering and vary in delicacy, the finest ones regis- 
tering in one minute, others in from three to five min- 
utes. The more expensive ones magnify the scale, 
and are therefore easier for the novice to read. Hick's 
thermometer is probably the best. 

The temperature is taken either in the mouth, rec- 
tum or armpit. Before using the thermometer the 
mercury must be shaken down to 95°. Be careful not 
to shake it into the bulb, or the thermometer will be 
rendered useless and also be careful not to hit it 
against anything, as it will break very easily. While 
in constant use it is best kept in a glass containing a 
little boric acid or listerine, with some soft cotton in 
the bottom of the glass. 



42 



HOME CARE OF THE SICK 



Temperature 
by Mouth 



When taking the temperature by mouth be sure 
that the patient has not had anything to eat or drink 
recently. Place the end of the instrument 
containing the mercury under the tongue, 
on either side. See that the lips are tightly 
closed all the time the thermometer is in the 
mouth, and do not leave it in place longer 
than necessary. 

Never take the temperature of a de- 
lirious patient nor a child by the mouth; 
they are likely to bite off the bulb and 
swallow the mercury. If this accident 
should occur give white of egg immediately 
and notify the physician. In such cases it 
is always safer to take the temperature by 
rectum and it is also expedient to take a 
rectal temperature when the patient is very 
ill, for this is the most accurate method. 

Before inserting the thermometer, the 
bulb should be oiled and precautions taken 
to have the rectum free from faeces. Five 
minutes should be allowed for registration. 
The temperature will be one degree higher 
than when taken by mouth. 
Thermometer The axillary temperature will be from 
three-tenths to half a degree lower than the mouth. 
The armpit must be wiped thoroughly before taking; 
the thermometer is then placed in the hollow, and kept 
in place by holding the arm close to the side and flex- 



SICK ROOM METHODS 



43 



ing the elbow so that the hand rests on the opposite 
shoulder. It will take ten minutes for the thermometer 
to register. 

The normal temperature of the human body is from 
98° F. to 99° F. The temperature is apt to be high- 
est between 4 p. m. and 8 p. m. and it reaches the 
lowest ebb about 3 a. m. This fact makes it essential 
that special care be taken of the sick in the early hours 
of the morning, the lowering temperature indicating 
a lower vitality. 

Though a rise of temperature is always to be re- 
garded with suspicion it must be remembered that 
many causes (especially with children) may create a 
slight deviation from the normal, without anything 
serious being the matter. Constipation will often cause 
a rise of temperature, sometimes even a slight cold, 
attack of indigestion, or undue excitement will do the 
same, while profuse perspiration or diarrhoea is apt 
to cause a sub-normal temperature. 

A sub-normal temperature is far more dangerous 
than the same number of degrees above normal. If a 
patient's temperature drops to 97.5° or 97" she should 
be rolled in blankets, a hot water bag put at the feet, 
another over the heart, and a cup of hot coffee or milk 
given. If the temperature does not soon respond to 
this treatment the doctor should be notified. 

The following table gives the different variations 
of temperature : 



Normal 
Temperature 



High 
Temperature 



Sub-Normal 
Temperature 



Temperature 
Records 



The Pulse 



44 HOME CARE OF THE SICK 

Hyperpyrexia. . . . 105° and over, extremely dangerous 

High Fever 103° 105° 

Moderate Fever ■ 101° 103° 

Sub-febrile 99>2° 101° 

Normal 98° 99^4° 

Siibnormal 97° 98° 

Collapse 95° 97° 

Algid Collapse Below 95°, extremely dangerous 

A record of the temperature is of great value, not 
only in diagnosis, but also in watching the course of 
the disease; it should therefore be charted every time 
it is taken. This can be done in figures, but the reg- 
ular clinical temperature chart conveys a clearer idea 
of how the temperature is running. The temperature 
should be taken at the same time each day; when it 
does not deviate much from the normal twice a day, 
morning and evening, is sufficient ; otherwise it should^ 
be taken every three or four hours, according to the 
nature of the case. 

A thorough knowledge of the pulse can only be 
gained by constant study and practice. It takes many 
months of careful observation of the numerous cases 
in the hospital ward, before the medical student or 
nurse can readily discern between the various charac- 
teristics of the different pulses. It is, therefore, im- 
possible to go very deeply into the subject here. 

The three principal things to be learned are: (i) 
How to count it; (2) to discern if it is regular or ir- 
regular; (3) if strong or weak. 



SICK ROOM METHODS 45 

To count the pulse place the index and middle fin- 
gers on the wrist, on the thumb side, where the radial 
artery can easily be felt. Count it for a full minute, di- 
viding the minute into quarters, as you can then tell 
if the frequency of the pulse is regular or irregular. 
For instance, if you count fifteen beats in one quarter 
and twenty in another, you will know that the fre- 
quency^ of the pulse is irregular. 

If some beats are strong and others weak the qual- 
ity of the pulse is irregular. By careful considera- 
tion of the pulse every time you take it, it soon becomes 
possible to realize where there is a difference in the 
quality of the pulse ; that is, when it is stronger or 
weaker. 

The pulse can be taken at the temporal artery when 
for any reason it is impossible to take it at the wrist, 
it also can be felt in the groin. 

The average normal pulse is : 

In men from 60 to 70 beats per minute 

In women from 65 to 80 beats per minute 

In children from 90 to 100 beats per minute 

Just as the temperature, even in health, is affected 
by certain conditions, so is the pulse ; food, exercise, 
excitement, will all cause an increase in the pulse rate. 

The pulse should always be taken and recorded at 
the same time as the temperature. The pulse is gen- 
erally written in figures. When there is any differ- 
ence in the quality, or if it is irregular this also should 
be recorded. 



To Count 
the Pulse 



Pulse by 
Temporal 
Artery 



46 



HOME CARE OF THE SICK 



The 
Bespiration 



A record of the respiration is also often required. 
The respiration being more or less under the control 
of the patient it is never wise to let her know that you 
are taking it; therefore, keep hold of her wrist, as 
though you were still counting her pulse, and watch 
the rise and fall of the chest. If you find it hard to 



Keeping 
Records 



J/ame : lUwm. Tard— — 








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Hour. 


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Hour- 


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^-.0 s* » « 




♦ * i V « ^ 


*» S ♦* tf 




Temp. 














T.mp. 


m 




,■•■■■• '• • "-. 






' • • ■• 




1«9 


,08 




.t ; .■ 






'■: :-• ; - 


SS^mSt 


wa- 


10! 


-■ . ' : * 










101' 


106' 

lo; 






: . . ,: 


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:-■':'■ 


m|:m:|Tl:Er:ti: 
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loi 












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lor 


















102 






..,,..,.. ,.,. 


'■; 'A 




mrij.m±im: 


lOJ* 


101 


['.:]:-: 








^ 




101' 


100' 




100* 












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»«• 


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:. :, ;-... 


.,.:,:,. 








if 


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. • 










«• 


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t< t< J H (i 






+ + •*■ a 4- 


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TEMPERATURE, PULSE, AND RESPIRATION CHART 

count by simply looking, hold the patient's hand on 
her chest, then you can feel the motion as well. This 
is generally the easier method for the beginner. Count 
it as you do the pulse, for a full minute in quarters. 
The inspiration and expiration count as one breath. 

Besides the temperature, pulse and respiration, a 
record must be kept of all medication given, and also 
of all changes in the patient's condition. If the pa- 
tient has pain note it, stating where the pain is and 



SICK ROOM METHODS 



47 



if it be continuous or only in paroxysms. When medi- 
cine is given to relieve the pain state with what re- 
sult. When the patient is on liquid diet, the amount 
of fluids taken during the twenty-four hours should 
be charted every morning. 

Mark every movement of the bowels; observe the 



C.«! 


H. 


P'ei&yteiun Hoif>l>l Bediid 


Dc, Remsrli 


0., 


^»-- 






it 




>n..t<^^^l. TW.'L^.l^ \\c.<«y» 




V^^ 


iO» 


.'^^^s^^vX.^z, A'^/^*^ ^ *t^^oS* ^«tot/ *^v «o ^«.^^ 




•s 






s--" 






31 




"Vtt,.<,VA''.' 'S;.o'v^^4 \\.c.v<<1i^'. 




cy./ 




A %K^%....^^ l,Jlf?.c,Vv <y V S " ■'■ 











BEDSIDE NOTES AS MADE IN A HOSPITAL 

movements carefully to see if there is anything abnor- 
mal in their appearance. If so, not only describe it in 
your record, but save the movement for the doctor's 
inspection. The same thing should be done if the 
patient vomits. 

When there is not sufficient urine voided, report it; 
also if there is anything untoward in its appearance. 



Important 



48 HOME CARE OF THE SICK 

Forty ounces is the amount that should normally be 
voided in twenty-four hours. In fevers there is apt 
to be less, and what is passed will be highly colored. 
In nervous diseases, on the contrary, there is likely 
to be a larger amount of a pale color. Perspiration, a 
Items chill or chilly feeling, coughing, expectoration, restless- 
ness, the amount of discharge from wounds, are all 
items of import of which the doctor must know the 
details to treat the patient understandingly. He never 
will fully know them unless they are clearly and con- 
cisely written down at the time they happen. 

The accompanying temperature chart and record is 
an example of hospital practice. 

THE GIVING OF MEDICINE 

A few rules to be remembered in giving medicines 
are: 

1. Always give exactly what the doctor orders, 
neither more nor less. 

2. Always give medicine on time — if a dose is due 
at twelve, give it at twelve and not at half past. 

3. Medicines intended to be taken before meals 
should be given twenty minutes before meal-time, 
those to be taken after eating, twenty minutes after 
the meal is finished. 

4. Never give medicine without reading the label 
on the bottle twice; before and again after pouring 
it out. 



Rules 



GIVING OF MEDICINE 



49 



5. When pouring medicine always hold the label 
on the upper side, to avoid defacing it. 

6. Do not use spoons for measuring for they are 
never accurate; small graduated glasses, which are 
infinitely better, can be bought at any drug store for 
about ten cents. 

7. When pouring hold the mark of the quantity you 
require on a level with your eye. 

8. Always shake the bottle before pouring out the 
medicine. 

9. The bottle should always be recorked immedi- 
ately after use, for many medicines contain volatile 
substances and are apt to become either stronger or 
weaker than intended, if left uncorked. 

10. Medicines containing iron should be taken 
through a glass tube or straw, as they discolor the 
teeth. 

11. Some medicines, notably several that are given 
for coughs, should be given undiluted, while others 
on account of their irritating properties should be 
very well diluted. Never dilute more than necessary, 
for the addition of a large quantity of water often 
renders a disagreeable dose still more unpleasant to 
take. 

12. Holding a piece of ice in the mouth for a short 
time before taking medicine will often render a dis- 
agreeable flavor less noticeable ; a drink of seltzer aft- 
erward will help to "take away the taste." Castor oil 
given with lemon juice, a piece of ice smpM enough to 



Measuring- 



To take 
away 
the Taste 



Powders 
and Pills 



50 HOME CARE OF THE SICK 

swallow, seltzer added just before taking, and a drink 
of seltzer after, is not at all unpalatable. Holding 
the nose while taking medicine will also diminish the 
taste. 

13. Insoluble powders such as calomel, bismuth and 
acetanilid should be placed far back on the tongue 
and washed down with a swallow of water. Those 
with a disagreeable taste can be given in jam or bread 
or encased in w^afers or capsules which can be bought 
for the purpose. 

14. Pills also can be made easier to swallow by 
giving in bread or jelly. Unless pills are freshly made, 
they should be pulverized, as they soon become so dry 
and hard that they will not readily dissolve in the 
stomach. 

15. Never buy a large quantity of medicine at a 
time, there are very few kinds that will not deteriorate 
by keeping; and because a medicine is beneficial in 
one case, do not imagine that you can give it to every- 
one whom you may think has the same ailment. 

16. Medicines should be kept in a cool, dry place 
and properly labeled. All poisons should be marked as 
such and kept under lock and key. 

Injections Medicine is occasionally given by rectum, either 

when a local effect is desired or when the stomach is 
unable to retain it. 

When medicine is given by rectum it is generally or- 
dered well diluted. The water, added for this purpose, 
should be warm enough to make the injection about 



GIVING OF MEDICINE 



51 



100° F. A rubber rectal tube, or a large size rubber 
catheter, connected by a glass connecting tube with a 
piece of rubber tubing about eighteen inches long, 
into the further end of which has been fitted a small 
glass funnel, are the best in giving medicinal enemata. 

Let warm water run 

through the tube to be sure 

that it is in working order ; 

this will also heat it and 

thus avoid cooling the med- 

Porceiain Feeding Cup ication. Grease the tube 

well, with oil or vaseline, and before inserting it fill 

the funnel with the solution, allow half of it to run 






GLASS DRINKING CUP 

through, back into the pitcher, pinch the rubber to pre- 
vent the rest running through. This is done to avoid 
getting air into the intestine. 

For sedative enemata (these generally consist of 
bromide or chloral) the tube is only inserted about six 



52 



HOME CARE OF THE SICK 



Nutritive 
Enemata 



Suppositories 



inches, but for stimulating enemata (brandy or whisky 
and salt solution) and nutritive enemata, the tube is in- 
serted about fourteen inches, and a small pillow placed 
beneath the hips to help the upward flow. When giv- 
ing these enemas have the patient lie on her back. 
Holding a folded towel to the anus, after the removal 
of the tube, will help the patient to retain the in- 
jection. 

Nutritive enemata generally consist of peptonized 
milk, white of tgg, salt and one of the beef prepara- 
tions made especially for that purpose; but every 
doctor has his own formula and will specify how he 
v/ishes it prepared. When patients are having nutri- 
tive enemata constantly they must have a cleansing 
enema daily, and this must be given at least an hour 
before the next nutritive one is due, and not till two 
or three hours after the last one has been given. 

Starch and other emollient enemata are sometimes 
given in diarrhoeas and dysentery. To prepare the 
starch mix a teaspoonful of laundry starch in cold 
water, add a teacupful of hot water, let it come to the 
boil. A few drops of laudanum are sometimes added 
to this ; when it is ordered, be very accurate in count- 
ing the drops. 

The suppository is another method of giving rectal 
medication. This is a conical shaped preparation of 
cocoa butter in which the required drug is incorpo- 
rated. It is oiled and gently inserted, pointed end fore- 
most, the patient lying on the left side. 



GIVING OF MEDICINE 



53 



Medication for the throat is often given by means 
of the atomizer. When using this see that the pa- 
tient's tongue is held down sufficiently to allow the 
spray to reach the affected parts, and be careful not 
to let the end of the atomizer touch the back of the 
patient's throat, as this tends to induce vomiting. 

The inhalation of vapor is another method of con- 
veying medication to the throat and also to the bron- 
chial tubes and lungs. Mix the medicine with boiling 



Inhalations 




HYPODERMIC SYRINGE 

water and put in a small kettle over an alcohol lamp. 
With stiff brown paper, make a cone, one end to fit 
over the mouth and nose, the other over the spout of 
the kettle. 

When rapid absorption is necessary medicine is 
sometimes given hypodermically. The hypodermic is 
a graduated syringe to which a hollow needle is at- 
tached. As hypodermic injections are attended with 
great danger unless properly given, no one should at- 
tempt to administer medicine this way without being 
personally instructed by a physician or nurse. In 
giving medication hypodermically, the greatest clean- 
liness should be observed; the flesh, where the injec- 



Hypodermic 
Injections 



54 HOME CARE OF THE SICK 

tion is to be made, must be well washed with alcohol, 
the needles should be attached to the syringe and alco- 
hol drawn into the syringe and expelled several times 
before the medicine is drawn in. When the syringe is 
filled with the required amount, expel the air by point- 
ing the needle upward and gently pressing the piston 
till a drop appears at the point of the needle. Be care- 
ful not to let the needle touch anything after it has 
been cleaned — if it should, hold it in the alcohol again 
for a minute before inserting. The injection may be 
given in the outer side of the arms, thighs or abdomen. 
Hold the flesh between the thumb and first finger of 
the left hand, plunge the needle in with one quick 
downward movement, inject the fluid slowly by gently 
pressing the piston. Draw the needle out quickly. Rub 
the spot where the injection was made for a few sec- 
onds to hasten absorption. 

Clean the instrument with alcohol before putting 
it away. 

PURGATIVE, ENEMATA, DOUCHES AND CATHETER- 
IZATION 

Cleansing The purgativc, or as it is also called, cleansing en- 

^^^^^ ema, is given as its name indicates for the purpose of 
washing out the intestines. It is generally resorted to 
when cathartic medicine fails to act, when immediate 
catharsis is necessary, or when for any reason the pa- 
tient is unable to take a cathartic by mouth. 

The long rubber rectal tube is the best appliance for 



ENEMAS 



55 



the giving of such enemata; the water is injected 
higher into the bowel and there is a steadier flow than 
when any of the bulb syringes are used. This can be 
attached by means of a connecting tube to the tube of 
the ordinary fountain syringe bag. See that the stop 
cock is on the tube. 

The cleansing enema generally consists of a soap 



Soap Enema 




GLASS DOUCHE NOZZLES 



suds made with ''ivory" or castile soap ; the froth of 
which should be removed as it contains too much air; 
the temperature should be about 98° F. Make the soap 
suds in a pitcher, pour it into the bag, let some run 
through the tube to warm it and expel the air, shut 
the stop cock, grease the rectal tube. Hang or hold 
the bag not more than three feet higher than the 
patient. 

The bed should always be protected with a rubber 
sheet and large towel, the patient lies on her left side 
with the knees well flexed. The tube should be in- 



55 HOME CARE OF THE SICK 

serted very gently, never use force, let the water run 
in slowly. If much pain is given shut the water off 
occasionally, for a minute or two. When a sufficient 
quantity has been given (two to three pints for an 
adult, one for a child) remove the tube quickly, but 
gently, and press a folded towel to the anus. The 
fluid to do much good should be retained from fifteen 
to twenty minutes. 

After use the tube must be carefully cleansed, wash 
it in warm soap suds and water, afterward let a quan- 
tity of hot water run through it' hang it up lengthwise 
to drip till perfectly dry. 

When used for more than one person the tube 
should always be boiled for five minutes after use. 
Vaginal Douclies are given, as a rule, either for cleanliness 

Douches Qj. ^Q relieve inflammation. When used for the former 
purpose the solution should be of a temperature rang- 
ing from ioo° F. to iio° F. When given to relieve in- 
flammation it is generally required very hot even ii8° 
or 120° F., and great care must then be taken not to 
burn the patient by having it any hotter ; mix the 
water well before you test it. Some disinfectant is 
often added, carbolic or bichloride being the ones most 
frequently used; they should, however, never be used 
without a doctor's order. In giving, the patient Hes 
on her back, have the douche pan placed under her 
properly so that the return flow of the water will run 
into it. Put a pillow under the small of the back. 
Before inserting the nozzle let the water flow through 



DOUCHES 57 

the tube, to expel the air. Insert gently and move 
it around while in. 

The douche nozzle should always be boiled or 
washed in boric acid, or other disinfectant, after use. 
Glass douche nozzles are preferable to any other. They 
can be attached to the ordinary fountain syringe. 

Catheterization improperly performed is fraught catheterization 
with feo much danger to the patient that it must not be 




GLASS CATHETER 

attempted till further instruction than can be given in 
writing is obtained. 

Catheterization is necessary when the patient is un- 
able to void urine naturally, but there are many simple 
devices which should all be tried before this is resorted 
to ; for instance, put hot water in the bed pan, allow 
water to run from a faucet within hearing (if this is 
impossible pour water from one vessel to another), 
squeeze a sponge dipped in warm water over the lower 
part of the abdomen, or hot stupes can be applied, and, 
this failing, the stupes can be alternated with ice. 



be Taken 



58 HOME CARE OF THE SICK 

In preparing to catheterize it is necessary to exer- 
cise not only the greatest cleanliness but asepsis. The 
catheter (glass ones are preferable for women) should 
be boiled for five minutes. Have at hand some small 
sterile swabs (see chapter on asepsis) in a solution of 
boric acid. Put the patient on the bed pan (leaving it 
further in front than for ordinary use), have the pa- 
tient's knees flexed and separated, drape a sheet 
around her legs, leaving the vulva exposed. Then 
wash the hands well with soap and hot water, soaking 
Care to them afterwards in a solution of bichloride of mer- 
cury, I -1000. With the left hand separate the labia, 
and carefully wash all around the meatus (the open- 
ing to the urethra, the tube leading to the bladder) ; 
into this opening the catheter is then carefully intro- 
duced, it must not be forced forward if any obstruc- 
tion is met with, but withdrawn slightly and the course 
changed. 

When the bladder is very much distended it should 
not be emptied entirely at one time; when a pint or 
a pint and a half has been withdrawn remove the 
catheter and insert it again four or five hours later. 

Before removing the catheter, the index finger is 
placed over the end ; this prevents drops of urine 
falling upon the bed. 



HOME CARE OF THE SICK 



59 



POULTICES AND FOMENTATIONS 

Poultices and fomentations are applied for the relief 
of localized pain, when caused by inflammation. The 
heat, by dilating the superficial blood vessels, draws 
the blood from the congested area. 

The linseed poultice is the one most generally used. 
To make it, stir the meal slowly and evenly into water 
while it is boiling. When it is thick enough not to 
run, boil it a minute more ; remove from the fire and 
beat it briskly. When properly made it is perfectly 
smooth, and just stiff enough to drop away from the 
spoon. Spread it on a piece of muslin the required 
size and shape, leaving an inch margin all round to 
turn over. The side which is to go next to the patient 
is best covered with cheesecloth or gauze. This is cut 
slightly larger than the muslin, so as to turn back 
over it to keep the contents of the poultice in place. 

Few poultices should be more than half an inch 
thick. They should always be applied as hot as the 
patient can possibly stand them. To keep the poultice 
warm while taking it to the bedside it can be placed 
between two hot plates or rolled in a piece of hot 
flannel. The flannel can be left over it when applied 
if there is no oil muslin or oil paper to be obtained; 
these latter are preferable, however, as they are very 
light and keep in the heat and moisture better. 

The poultice is kept in place by a bandage. A muslin 
binder is the best means for keeping a chest poultice 
in place. Poultices should always be shaped to fit the 



Linseed 
Poultice 



Applying 



63 



HOME CARE OF THE SICK 



starch 
Poultice 



Sinapisms 



affected part. They should be changed at least every 
two hours. 

Starch poultices are used in certain skin diseases. 
The starch is mixed with a little cold water, then 
enough boiling water added to make a thick paste. 
It is boiled, spread and applied in the same manner as 
the flaxseed. 

The cotton jacket or ''dry poultice" is made by 
tacking a layer of non-absorbent cotton or wadding 
between two pieces of cheesecloth, shaped for the 
chest, and is excellent to keep on for a few days after 
other poultices have been discontinued. 

Sinapisms relieve pain through the agency of the 
mustard which, by irritating the sensory nerves, causes 
the dilatation of the superficial blood vessels — under 
the point of application — and the consequent lessening 
of the congestion in the inflamed tissue. Sinapisms 
are made of flour, mustard, and tepid water, in vary- 
ing proportions. Those for a man are generally made 
one part mustard to four of flour; for a woman one 
part mustard to six of flour ; for a child one part 
mustard to ten of flour. The water used should always 
be tepid; cold water feels uncomfortable to the pa- 
tient, while hot destroys the virtue of the mustard. 
Tl^ flour and mustard are first mixed well together, 
care being taken to crush all lumps of mustard ; enough 
water is then slowly added to make a thick paste, 
which is spread on muslin and covered with gauze. 
The sinapism is generally left on from fifteen to 



FOMENTATIONS 



6i 



twenty minutes, but it must be watched carefully, and 
removed as soon as the surface of the skin is well 
reddened, as otherwise it will blister. After the re- 
moval of the sinapism the skin must be washed, and 
if a little vaseline be rubbed on, this will allay the 
irritation. 

The usual method of applying fomentations is to 
have two pieces of flannel in use, applying them alter- 
nately and changing every three minutes for twenty 
minutes. The easiest way is to have the water boiling 
over an alcohol or gas lamp near the bedside. 

Put two layers of coarse, soft flannel (an old blanket 
is good) in the center of a towel ; dip this into boiling 
water, wring it out by twisting the ends of the towel, 
give the flannel a quick shake, and apply the flannel; 
cover with oiled muslin or oiled paper. 

As hot applications promote suppuration there are 
conditions when their use is contra-indicated and cold 
applications are ordered. 

The most eflfectual way of applying continuous cold 
is by means of the ice cap. The pieces of ice put into 
the cap should be about the size of a walnut ; it should 
never be more than half filled, and the air should be 
expelled before putting on the cover. Salt is some- 
times mixed with the ice to intensify the cold. The 
cap should be tied in an old handkerchief or piece of 
gauze to prevent the rubber from coming next the skin, 
as the extreme cold is very irritating, and may even 
produce frost bites. 



Fomentations 



Cold 
Applications 



62 HOME CARE OF THE SICK 

Ice Caps When ice caps are being used all the ice must not 

be allowed to melt before the cap is refilled, as the 
reaction caused by the resulting change of temperature 
* is very injurious, especially if there is any inflamma- 
tion. 





ICE CAPS 

Compresses Foi* the application of cold to the head, old hand- 

kerchiefs or pieces of soft gauze can be used, folded 
so that they will come down well over the temples, but 
not touch the pillow. They must not be wide enough 
to wet the hair, or come far down over the eyes. Com- 
presses should not be made too wet. The best scheme 
is to have a piece of ice in a basin, and two compresses, 
then while one is on the forehead the other can remain 
rolled round the ice. 

Compresses for the eye should be small and very 
light. If both eyes need the compresses two separate 
ones should be used. If only one eye is affected be 
careful that the compress on it does not touch the 
other, lest it should become infected. If gauze is used 
for compresses always turn the ends in, that the 
ravellings may not annoy the patient. 



TEST QUESTIONS 

The following questions constitute the ^Vritten reci- 
tation" which the regular members of the A. S. H. E. 
answer in writing and send in for the correction and 
comment of the instructor. They are intended to 
emphasize and fix in the memory the most important 
points in the lesson. 



HOME CARE OF THE SICK. 

PART I. 



Read Carefully. Place your name and address on the 
first sheet of ihetest. Use a light g-rade of paper and write 
on one side of the sheet only. Do not copy answers from 
the lesson paper. Use your own words, so that your in- 
structor may know that you understand the subject. Carry 
out the directions given in the text, if possible, before answer- 
ing the questions. 

1. What is expected of the nurse? 

2. Give the period of incubation, first symptoms, 

and time required for isolation for: (a) 
Mumps, (b) Measles, (c) Smallpox, (d) 
Scarlet fever, (e) Diphtheria. 

3. What are the causes of cholera infantum? 

Symptoms? What are the symptoms of in- 
testinal obstruction? 

4. What are the most common causes of convul- 

sions in children ? What should be done ? 

5. What are the primary symptoms of typhoid 

fever? Of pneumonia? Of meningitis? 

6. What is the difference between false croup and 

true croup in symptoms, danger, and treat- 
ment ? 

7. Describe the ideal sick room. 

8. How should the sweeping and dusting be done? 

How prepare for the night? 

9. Why is ventilation in the sick room important? 

Describe different methods. 
10. Make the bed as explained in the lesson and then 
describe the process. 



. HOME CARE OF THE SICK 

11. Endeavor to change the bedclothes with a per- 

son in bed and report your success. 

12. The points suggested- in the section on the "Care 

of the Patient" are all essential. What ones 
might you neglect if you had no experience? 

13. What must be guarded against in lifting and 

moving a helpless patient? 
14., How would you change a patient from one bed 
to another? 

15. What are bed sores and how can they be guarded 

against ? 

16. How would you wash the hair? 

17. Describe the process of giving a bath in bed. 

18. How can the heat of the blood be found? Why 

is it important? 

19. How would you count the pulse? 

20. Mention some of the points in a patient's condi- 

tion that should be noted and recorded ? 

21. What rules should be observed in giving medi- 

cines ? 

22. What are the different kinds of enemata? How 

given ? 

23. What devices can be tried before catheterization 

is attempted? 

24. How is a linseed poultice made and applied ? 

25. What is a sinapism? A fomentation? 

26. How is cold applied to relieve pain? 

2y. Do you understand everything in this lesson? 
What questions occur to you? 

Note. — After completing the test sign your full name. 



HOME CARE OF THE SICK 

PART II 



CONTAGION; DISINFECTION— NUKSING IN CONTA- 
GIOUS DISEASES 

We have learned in our study of Household Bac- 
teriology that nearly all diseases, especially those com- 
ing under the head of infectious and contagious, are 
caused by certain species of bacteria. 

If we would be immune from these diseases, then 
we must do everything in our power to exclude these 
germs. Cleanliness, plenty of sunlight and fresh air, 
are the first requisites for their exclusion; and, when 
disease has entered, proper isolation and disinfection to 
prevent their spread. 

By disinfection we mean destruction of the bacteria 
by use of certain chemicals or heat. Heat, when it 
can be used, is always the surest and quickest method. 
The rules for disinfection, or sterilizing by heat, will 
be given under the head of ''Surgical Operations at 
Home." 

The disinfectants most commonly used in illness 
are bichloride of mercury, i-iooo, for the hands and 
utensils, and carbolic acid, 1-20, for the clothes, instru- 
ments, etc. Bichloride is the stronger disinfectant, 
but as it discolors clothes and instruments it should 
not be used for them. 



Disinfection 



Bichloride 
of Mercury 



Carbolic 
Acid 



Infection 

and 

Contagion 



64 HOME CARE OF THE SICK 

MAKING DISINFECTANT SOLUTIONS 

A bottle of blue bichloride tablets can be bought at 
any chemist's ; this is the safest form to use it in the 
home, as the tablets make a blue solution. The bi- 
chloride is perfectly odorless, and if the clear, uncol- 
ored solution were used it might be mistaken for 
water. As this is a very strong poison the tablets 
should be kept always under lock and key, and out of 
the reach of children. It is well to have a bottle 
of tablets in the house at all times, to use in case of 
cuts, etc. They contain salt, which is always required 
in making bichloride solution. 

To make bichloride solution dissolve one tablet in 
a quart of hot water. 

When a large quantity of carbolic acid solution 
will be required continually, it is cheaper to buy the 
95 per cent solution, which can be reduced as needed 
to the required strength. To make five pints of 1-20, 
mix four ounces of the 95 per cent carbolic with five 
pints of boiling water and shake the bottle well. 

As 95 per cent carbolic is not only a strong poison, 
but also very corrosive to the skin, so be careful not to 
spill even a drop on your hands, but if you should, 
wash the spot immediately with alcohol or warm water 
and soap. 

An infectious disease is not always a contagious 
one; that is, it cannot be contracted by being in the 
same room with the patient, but it is transmittable 
by some intermediate means of communication. 



CONTAGION AND DISINFECTION 



65 



Tuberculosis is not contracted by coming in contact 
with a patient suffering from that disease, but by 
inhahng dust containing the germs derived from the 
dried sputa of some consumptive person. 

The germs of typhoid fever are disseminated when 
the stools and other excreta of the patient are not 
properly disinfected by those in charge. 

It is not necessary to isolate patients suffering from 
diseases of this kind, but it is necessary to disinfect, 
according to the nature of the infection ; thus, know- 
ing that the germ of typhoid fever is in the stools, 
and to some extent in the urine, the stools and urine 
must always be disinfected by covering with bichloride, 
i-iooo, and letting stand half an hour before empty- 
ing. The bed pan must be well washed and disin- 
fected afterward. It is also a wise precaution to 
disinfect the bed-clothes by soaking in carbolic, 1-20, 
for twelve hours, and then boiling; also to keep uten- 
sils and dishes used for the patient separate, boiling 
them before they are again mixed with the household 
supply. 

Consumption, or tuberculosis of the lungs, is per- 
haps the most dreaded disease of the present day. 
There are more deaths from it than from any other, 
except in times of epidemic. The sputum of patients 
suffering from this disease contains many millions of 
the bacilli. If this is deposited in places where it is 
allowed to dry and become pulverized, it is a source of 
danger to others. The sputum must, therefore, be 
disinfected. 



Disinfection 

Without 

Isolation 



Consumption 



66 



HOME CARE OF THE SICK 



^^^ 



Patients suffering from this disease should be pro- 
vided with sanitary cups. The best for this purpose 
are made of prepared paper and are 
very cheap. These should be burnt 
after being in use for twelve hours 
at most. If these cannot be obtained, 
porcelain ones with covers may be 
used, but bichloride or carbolic must 

Sanitary Cup. , • • -i j -i. 

always remam m the cup, and it 
should be emptied and scalded frequently. The patient 
should not use ordinary handkerchiefs, but gauze or 
Japanese paper, which should be burnt. All clothing 




Paper Sanitary Cup. 



and bedding soiled by the sputa should be disinfected 
in the usual manner, and the sufferer should wash 
and disinfect the hands frequently. 

Perfect cleanliness, plenty of sunlight and fresh 



CONTAGION AND DISINFECTION 



67 



air, and nourishing food are the most important points 
in the modern treatment of consumption. Special care 
should be taken by consumptives to smother every 
cough when close to other people. 

CONTAGIOUS DISEASES 

Measles, scarlet fever, smallpox and diphtheria are 
not only infectious but also contagious, and can be 
taken by touching the person or anything that has 
come in contact with the patient. 

Anyone who has been in the room with a patient 
suffering from any one of these diseases can scatter 
the germs far and wide; this must be remembered, 
especially by those who do the nursing. It is an abso- 
lute necessity for them to go out every day, but before 
doing so they should change all their clothes, and wash 
face and hands with bichloride, i-iooo. As it would 
be impossible to wash the hair every time, it should 
be covered by a cap, while on duty. Even when all 
these precautions have been taken, shops, theaters, and 
street cars should be avoided. 

The rules of isolation are these: 

(i) The patient should be removed to a room as 
remote as possible from the rest of the house. 

(2) No one should be allowed to enter the room 
except the physicians and attendants. 

(3) Long-sleeved aprons and caps which will cover 
the hair should be worn by physicians and attendants 
while in the room. (These can be made of cheap 
muslin.) 



The Spreading 
of Germs 



Rules of 
Isolation 



68 



HOME CARE OF THE SICK 



Disinfection 
of Clothes 



Dishes 

and 

Utensils 



(4) A solution of bichloride, i-iooo, should be 
kept by the wash basin for the disinfection of hands, 
and they should be disinfected every time after touch- 
ing or doing anything for the patient. For proper 
isolation there should be two rooms, — the wash stand, 
gowns, disinfectants, etc., being kept in the outer 
room. 

(5) A foot tub or other receptacle containing car- 
bolic, 1-20, should be placed near the bedside when 
the clothes are about to be changed, and they should 
be put immediately into this, remaining there well 
covered for twenty-four hours. They should, even 
then, be boiled before being washed. 

(6) The advice given earlier as to the furnishing 
and care of the sick-room is especially applicable in 
cases of contagious diseases. When dusting, the 
duster should be dampened in 1-40 carbolic. As bare 
floors are apt to be noisy, a small rug or two may be 
retained, but they should be old ones, as they ought 
to be burned at the termination of the disease. They 
must not be shaken, as at other times, but kept well 
dusted with the damp duster. 

(7) It is well to keep sheets, wrung out in car- 
bolic, 1-20, both between the two rooms set apart for 
the nursing and at the entrance of the outer room. 
The door of the latter must be kept closed. 

(8) The dishes and utensils used by the patient 
and attendants must not be removed from the room ; 
they must be washed there, the patient's always being 



CONTAGION AND DISINFECTION 



69 



washed and kept separate. When food is brought it 
should be left at the door of the outer room. The 
attendant, first taking off her cap and apron and disin- 
fecting her hands, should remove the food from those 
dishes to the ones she has in the room; the others 
should be removed immediately. 

(9) Whenever it can be managed the isolated 
rooms should be in close connection with a bath-room, 
which should be set apart for the use of the inmates 
of the sick-room. When this is impossible the attend- 
ant must, when it is necessary to go there, first remove 
her cap and apron and disinfect her hands. When her 
object is to empty the slop jar or bed pan they should 
be completely covered with a large towel wrung out in 
carbolic. 

(10) The bed pan should always have bichloride, 
I -1000, in the bottom, and after use more of the same 
solution should be added. It should stand thus for 
half an hour before being emptied. When there is no 
separate bath-room a tightly covered box nailed on the 
outside window sill of the outer room will be found 
convenient to hold the bed pan, while its contents are 
being disinfected. 

Besides the general rules for disinfection there are 
in some contagious diseases special rules, incidental to 
the nature of the disease. 

In scarlet fever the greatest danger of infection lies 
in the dissemination of the skin, while it is peeling. 
To prevent this the patient should be rubbed all over. 



Separate 
Bath Room 



Special 
Rules 



70 



HOME CARE OF THE SICK 



night and morning, with carbolized vaseline or boric 
ointment. 

In diphtheria the most virulent contagion is in the 
expectoration, especially when the membrane loosens. 
Soft gauze should be used instead of handkerchiefs, 
and if there is no grate in the room a pan must be at 
hand, in which these can be burnt immediately after 
use. 

DISINFECTION AT THE TERMINATION OF THE DISEASE 



Time of 
Quarantine 



Disinfecting 
the Patient 



Even after the fever has abated it is necessary to 
keep the patient isolated, or "in quarantine," as it is 
called, for some days. A rough estimate of the time 
required for quarantine in the different diseases is 
given in the table in the first section, but the doctor 
should always be the one to decide when it may be 
raised, as circumstances or complications may arise 
which might make it allowable to shorten or neces- 
sary to lengthen the time. 

When the doctor does allow the patient to be moved, 
a warm cleansing bath (including the washing of the 
hair) must be given. This is followed by a bichloride 
bath, I -1000, and an alcohol rub. The patient is then 
wrapped in a clean sheet and taken to a different 
room, where fresh clothes which have not been in the 
sick-room are put on. Those who have done the nurs- 
ing must go through the same procedure. 



CONTAGION AND DISINFECTION 71 

THE DISINFECTION OF THE ROOM AND ITS CONTENTS 

The use of sulphur fumes as a disinfectant has been 
proved to be practically useless, and formaldehyde has 
almost entirely replaced it. The easiest form of using 
this is the 'Ture Formaldehyde Gas" put up by Sea- 
bury & Johnson, It can be procured at most drug- 
gists. In appearance it looks like a stone, cone shaped. 
There are two sizes ; the smaller, 2 inches square, will 
disinfect a room 500 cubic feet, and the larger one, 
1000 to 1500 cubic feet. Close the windows, pasting 
paper over all the cracks ; pull down the blinds ; open 
cupboards, drawers, bundles, etc., that everything may 
be exposed to the fumes of the gas ; place the fumi- 
gator on the'top of an inverted pail — it must not be too 
near the floor, or it may scorch it — set fire to the top 
of it, and leave the room ; lock the door and paste up 
the cracks and key hole. 

Leave the room thus for five or six hours, then 
open all the windows, if possible allowing them to 
remain open for twelve hours. 

Books and toys used in the sick-room should be 
burned, as they are hard to disinfect. 

Unless the mattress can be baked it should be 
opened, so that the formaldehyde can penetrate 
through to its center. In all large cities there are bake 
houses where such things may be sent for disinfection 
at comparatively small cost. They should be carefully 
wrapped up. 



Disinfectingr 
with Formalde- 
iiyde 



The 
Mattress 



Disinfection 



72 HOME CARE OF THE SICK 

PERSONAL PRECAUTIONS TO BE TAKEN BY THOSE NURSING 
CONTAGIOUS DISEASES 

( 1 ) Take sufficient sleep and rest ; never in the 
patient's room. It is when the muscles are relaxed, 
as they are when resting, that the greatest danger of 
infection comes. 

(2) A daily walk in the fresh air is necessary. 

(3) A daily bath; change of all clothing at least 
three times a week. The clothing must be disinfected. 

(4) When working over the patient never stoop 
so that you inhale her breath. Never kiss your pa- 
tient. 

Personal (s) Never put your hands to your face, especially 

your mouth or eyes, without first disinfecting them. 

(6) Disinfect your hands frequently in bichloride 
of mercury, i-iooo. Keep the nails short and scrupu- 
lously clean. When washing the hands wash the 
soap ofif before putting them into bichloride, or they 
will soon become sore. 

(7) Before meals wash and disinfect your hands 
well, rinse your mouth with boric acid solution or 
listerine. Never eat in the patient's room. 

(8) When irrigating a diphtheria patient's throat 
tie a handkerchief over your mouth, and wear glasses 
to protect the eyes. 

The nursing in infectious and contagious diseases 
is the same as in all other cases of fever. While the 
temperature is high the patient should be kept in the 
recumbent position to avoid strain upon the heart. 



SURGICAL OPERATIONS yz 

In typhoid this position is particularly necessary, as 
hemorrhage from the intestines is liable to occur if it 
is not strictly adhered to. 

Nourishment and medication must be given exactly Nourishment 
as ordered. When the doctor orders fluids give noth- 
ing' solid; many a Hfe, especially after typhoid, has 
been lost by so doing. 

Except when the patient is nauseated, unless con- 
trary to orders, give plenty of water, every two hours 
at least. See that the patient drinks it slowly. 

Remember the rules already given about the care of 
the mouth, especially with typhoid patients. Vaseline 
applied to parched lips gives relief. 

In measles and scarlet fever the eyes are apt to be ©are of 
affected, so the room should be kept darker than in * ® ^^®^ 
other cases, and the eyes should be washed with boric 
acid, always bathing from the inner angle outward. 

In all diseases where the skin is not working prop- 
erly, as in measles, scarlet and other eruptive fevers, 
be especially observant of the urine as various kidney 
complications are liable to ensue. 

There is little danger of the patient catching cold 
while the temperature is high, but when it begins to 
lower be doubly careful. 

SURGICAL OPERATIONS AT HOME* 

For twenty-four hours previous to operation the 
patient should be given broths every two hours, but 
neither milk nor solid food. A cathartic is given, if 
possible, thirty hours prior to operation, and repeated 

*This section is optional. 



74 HOME CARE OF THE SICK 

in six hours; a soap suds enema is given three hours 
after the first cathartic, and repeated twelve hours 
before operation. A bath is also given the afternoon 
before, and after the bath the field of operation is 
Preparation shaved, then thoroughly cleansed with green soap, 
for an and a compress wet with green soap solution, 25 per 
cent to 50 per cent, applied (the Hquid green soap 
which is used for this purpose can be obtained at any 
druggist's) ; this is covered with a protector — oil mus- 
lin or oil paper — and left on from three to six hours, as 
the skin will bear. When removed, the surface is 
washed in the following order, with green soap, ether, 
alcohol, and solution bichloride of mercury, i-iooo; a 
compress wet in the latter is applied covered with a 
protector, and left on till an hour before operation, 
when the process is repeated and the fresh bichloride 
compress is left on till the doctor removes it on the 
operating table, after the patient is under the influ- 
ence of the anaesthetic; then he re-scrubs it, and the 
ether, alcohol, and bichloride must be ready for him 
to use. All these precautions are taken to kill or re- 
move every bacterium or spore. 

For a vaginal operation the rules for diet, catharsis, 
enemata and bathing are the same as for any other. 
In addition a green soap douche is given on the pre- 
ceding day, followed by one of bichloride of mercury, 
1-5000. The vulva is then covered with a pad wet in 
solution of bichloride of mercury, i-iooo, until two 
hours before operation, when another bichloride douche 



SURGICAL OPERATIONS 



75 



is given, the parts cleansed and a fresh bichloride pad 
applied. 

Just before the anaesthetic is given, the patient 
should void urine. If she has false teeth they should 
be removed. 

The Room. In the choice of the room the light is 
one of the first considerations, a good light being a 
positive necessity. If possible the operation should 
take place in a different room from the one the patient 
is occupying beforehand. Remove rugs, carpets, all 
unnecessary furniture, curtains and draperies. A piece 
of cheesecloth tacked across the lower sash of the 
windows will keep the light from being too glaring 
and obstruct the view from outside. 

The day before the operation ^the walls should be 
dusted, especially the cornices and mouldings ; the 
floor should be scrubbed if possible, or at least wiped 
with a damp cloth and it should be washed over again 
the morning of operation after the furniture is in 
place. 

If the patient is to remain in the room after the 
operation, have the bed as nearly in the position it is to 
occupy later as possible, but out of the way. 

Protect the floor under and around the operating 
table with several thicknesses of paper, covered with a 
sheet tacked down at the corners. 

A kitchen table covered with a couple of old blankets 
protected by a rubber pinned or tacked under the 
table will answer for the operating table. Three small 



The Room 



Operating 
Table 



76 HOME CARE OF THE SICK 

tables should be at hand, protected with papers, cov- 
ered with large sterile towels. On one table, con- 
venient to his right hand, the surgeon will need his 
instruments. On the second table have three bowls 
which have been well washed first with soap and hot 
water, then bichloride, i-iooo. The inside of the 
bowls should not be dried. One bowl is intended to 
hold the solution for the disinfection of the surgeon's 
and his assistant's hands, the other two for washing 
the sponges. The third table is required for the 
dressings and sterile towels. The former, the doctor 
will provide or tell you where to get them. Very 
reliable sterile dressings are now put up by Ellwood 

St6rile 

Dressings Lee, and can be procured at any drug store. They 
are really better than anything that can be prepared 
without a sterilizer. If it is impossible to obtain these, 
the dressings should be prepared in the same manner 
as the towels, namely, rolled in bundles not more than 
9 inches square (or the heat will not penetrate) and 
steamed in the clothes boiler for at least one hour. 
If there is no tray to keep them out of the water a 
hammock of gauze will answer the purpose. They are 
then dried in the oven, which must not be hot enough 
to scorch them. 

At least a dozen and a half towels will be required. 
The surgeon will bring the instruments and anaesthetic. 
If chloroform is administered, some vaseline will be 
required to grease the patient's face. 



SURGICAL OPERATIONS 



77 



An ether cone can be made out of paper, covered 
with a towel. 

An irrigator or douche bag must be at hand for the 
irrigation. This should be sterilized by boiling for five 
minutes, as are also the surgical instruments. 

There must be plenty of sterilized water prepared, 
six gallons at least, two gallons 
of which must be boiled long 
enough beforehand to be cold. 
This must be kept tightly cov- 
ered after it is boiled, or it will 
not remain sterile. Water must 
boil at least thirty minutes to be 
properly sterilized. 

Bichloride, carbolic and salt 
solutions may be needed and 
must be at hand, as well as two^%"apeTco?ereS'^S''''' 
sterile pitchers, a pus basin, a atowei. 

chair, a blanket or two to cover the patient, two rub- 
bers to protect the blanket, a slop jar, hypodermic 
syringe, and stimulants — the doctor will give definite 
instructions regarding the last. 

The bed is made according to the directions already 
given for bedmaking, w^ith the exception that no pillow 
wall be required as the patient's head must be kept low. 
Instead, a small rubber covered by a towel is desirable 
to protect the bed if the patient is nauseated. A 
blanket is put over the patient, before the upper sheet ; 
hot water bottles should be in the bed all the time she 




sterilized 
"Water 



The Bed 



78 HOME CARE OF THE SICK 

is on the table; a couple of towels and pus basin 
should be on a table near the bed in case of nausea, 
also small pieces of gauze to wipe the mucus out of 
the mouth, and a wedge-shaped piece of wood to put 
between the teeth if they become clenched, 
sterilizing ^^ neccssary to assist the surgeon during the opera- 

tion, scrub the hands for ten minutes with hot water 
and soap, using a new stiff nail brush which has been 



the Hands 




PORCELAIN BED PAN 

soaked in carbolic, 1-20. Be particularly careful of the 
finger nails, which should be cut very short. After 
scrubbing, the hands should be soaked in bichloride, 

I-IOOO. 

Nobody, whose hands have not been so treated, 
must touch the dressings or instruments, and after 
washing nothing but the sterile things must be touched. 
After the When the operation is over, if the patient's night- 

Operation gQ.^-,^ {^ Y^et it must be changed. She is then covered 
with a warmed blanket, and put into bed. She should 
lie on her back without pillows and be kept very quiet. 



SURGICAL OPERATIONS 



79 



If she vomits, hold her head on one side to prevent 
strangulation. 

Washing the mouth out, as previously directed, will 
help to relieve the thirst which is generally intense 
after an anaesthetic. 

'After a few hours either crushed ice or very hot 
water, in teaspoon doses, may be given. 




Bed Pan, "Eureka" Pattern 

The pulse must be watched carefully, and if its rate 
increases should be reported to the doctor, as this, 
together v/ith pallor, restlessness, longing for fresh air, 
sighing respiration, and fall of temperature is a sign 
of hemorrhage. As the hemorrhage does not always 
show through the dressing these signs must be watched 
for. 

For treatment of hemorrhage see the section on 
''Emergencies." As the after treatment depends alto- 
gether on the nature of the operation, and subsequent 
condition of the patient, no rules for it can be given 
here further than to emphasize the fact that the first 
requisite for success in surgical work is perfect clean- 
liness. The gauze used for dressing the wound after 
the operation, the instruments and the hands of those 



The Pulse 



Perfect 
Cleanliness 



8o HOME CARE OF THE SICK 

touching these things, must always be as carefully 
sterilized for the dressing as for the operation. 

The diet, like the treatment, will depend upon cir- 
cumstances. For the first day or two the patient is 
generally on fluid diet, and care must be taken that it 
is given slowly and in small quantities, but as soon as 
possible plenty of nourishing food should be given to 
build up the system. 

OBSTETRICS 

The average duration of pregnancy is 280 days. 
The most accurate way of calculating the probable date 
of confinement is by counting back three months from 
the date of the cessation of the last menses and adding 
seven days. 
Preliminary The expectant mother should place herself under 

the doctor's care in the early stages of pregnancy, as 
not only her own but the infant's after health depends 
largely on the care the mother takes of herself at this 
time. The principal rules of hygiene to be followed 
are: 

1. Daily exercise in the open air. 

2. At least eight hours' sleep out of twenty-four. 

3. A daily bath, a sponge bath if the tub bath is 
too exhausting. A brisk rub after the bath will cause 
a good reaction. 

4. The bowels should be moved daily, with mild 
cathartics if necessary. 



Care 



OBSTETRICS 8i 

5. The urine must be carefully watched and any 
abnormality reported to the doctor. Frequent speci- 
mens should also be sent him, as there may be danger 
of serious kidney troubles. 

6. Freedom from excitement, worry, hurry, and 
too heavy manual labor. 

7. The clothing should be worn loose enough to 
allow of free circulation. 

8. A nourishing, but not too stimulating diet 
should be adhered to. 

9. The nipples require attention, especially during 
the last two months, and should be washed twice daily 
with boric acid solution and treated with fresh cocoa 
butter or albolene. 

What to provide : For the 

1. Two large rubber sheets. 

2. If possible, a Kelly Pad, if not, make an obstet- 
rical pad, consisting of four thicknesses of cotton wad- 
ding, covered with a layer of absorbent cotton, the 
whole encased in absorbent gauze and tacked to keep 
the cotton in place. This pad should be three-quarters 
of a yard square. 

3. Two dozen pads for dressings, half a yard long, 
ten inches wide and two inches thick, made of the 
same materials. 

4. Two dozen smaller pads. 

5. Five boxes of sterile gauze (each containing one 
yard of gauze), to be used both for the mother's 
dressing and to cover the baby's cord. 



Mother 



82 . HOME CARE OF THE SICK 

6. One roll of adhesive plaster. 

7. Six abdominal binders of unbleached muslin. 

8. Six breast binders of unbleached muslin. 

9. One pair long stockings made of flannel or an 
old blanket. 

10. Two dozen paper bags in which soiled dress- 
ings can be put and burnt. 

11. At least two hot water bottles. 



KELLEY PAD. 

12. Bed pan — "Perfection" is the best. 

13. Douche pan. 

14. Douche can .or new fountain syringe bag. 

15. Two glass douche nozzles. 

16. Two glass catheters. 

17. One agate basin to boil nozzles and catheters in. 

18. Two large agate pitchers in which water can 
be sterilized, solutions made, etc. 

19. CHnical, room, and bath thermometers. 

20. One bottle carbolic, 4 per cent. 

21. One bottle Lysol. 



OBSTETRICS 83 

22. One bottle bichloride tablets. 

23. New nail brush and fresh cake of soap for the 
doctor's use. 

• For the baby: • ^or the 

1. A tube of sterile tape. ^^^^ 

2. A rubber sheet, or, preferably, a nursery cloth 
to protect the crib mattress. 

■ 3. Talcum powder. 

4. Sweet oil or sterile vaseline. 

5. Pure castile soap (never use perfumed soap of 
any kind). 

6. Bath tub — good rubber ones are the best. 

7. Old table linen makes excellent towels and wash 
cloths for the baby. 

8. A large square of soft, thick flannel to roll baby 
in after it is greased. 

9. Basket containing sewing materials and safety 
pins. 

10. Crib and bedding. 

11. Scales to weigh the baby in are very desirable. 

12. A rubber or padded lap protector for the at- 
tendant to use while bathing the baby. 

13. A large flannel apron for the same purpose. 
The latter is especially desirable as the baby can be 
rolled in it, when taken from the bath. 

14. Baby's clothing: Six flannel bands, not 
hemmed, 6 inches wide, three-quarters of a yard long. ^°^ ^aby 
Four knitted or woven shirts. Six flannel petticoats. 

Six white petticoats ; these should all be made without 



84 



HOME CARE OF THE SICK 



The Bed 



Doctor's 
Table 



Nurse's 
Table 



bands, and the fastening on the shoulders, running a 
draw tape through the hem of the flannel petticoat, 
will keep the baby's feet warm without confining them. 
Six slips for night wear. Six dresses. Diapers, two 
sizes, eighteen and twenty-two inches square. 

As in other cases of sickness, the room should be as 
large, light, and airy as possible, scrupulously clean, 
and have no superfluous furniture. 

In this instance the foot of the bed should be to- 
wards the light. It should be made as shown in the 
section on bed-making, with the addition of a second 
rubber covered with a clean sheet, and either a rubber 
Kelly pad or an obstetrical pad (made as already 
described). 

The furniture and floor should be protected in the 
same manner as they are for operations. 

Besides the bed a table for the doctor, wash stand, 
nurse's table, extra table or bureau and chair will be 
required. See that there is a hook on which to hang 
the douche bag. 

On the wash stand have hot and cold water, soap, 
nail brush, scissors, and nail cleaner, towels, and bowl 
of bichloride, i-iooo. 

On the doctor's table, bowl of bichloride, 1-3000, 
with towels and sponges in it ; bowl of lysol, sterile 
towels, sterile douche tip, also rubber and glass 
catheter. 

On the nurse's table have (for baby) sterile scis- 
sors and tape wipes in boric acid (these consist of 



OBSTETRICS ' 85 

small squares of gauze), two large squares of gauze 
to put over the baby's mouth if necessary to blow into 
it, soft flannel square to wrap baby, in, dressing for 
cord as ordered by the doctor. 

For the mother — chloroform, mask, pus basin, ster- 
ile dressing and pads. Under the table the douche pan 
(which has been washed in bichloride and kept cov- 
ered with towel, wrung out in same), slop pail and 
basin, paper bags for soiled dressings and placenta, 
foot tub, hot and cold water. 

On the bureau — room, bath and clinical thermom- 
eters ; salt, vinegar, alcohol, whisky, hypodermic 
syringe, binders, pins, hot water bag, tray and alcohol 
lamp. 

The signs of beginning labor are pains in the lower 
part of the abdomen and back, occurring at regular ^^^^^ 
intervals, about once every half hour, and a discharge 
of mucus tinged with blood from the vagina. 

True pains can be distinguished from false by plac- 
ing the hand over the lower part of the abdomen ; in 
true pains the contractions of the uterus are to be 
readily felt through the abdominal wall. As the labor 
advances the pains grow more severe and the intervals 
shorter. The first stage of labor consists in the dila- 
tion of the uterus, and ends when the membranes have 
ruptured and the uterus is completely dilated. 

The second stage or stage of expulsion ends when 
the child is born. 



First 



86 HOME CARE OF THE SICK - 

The third stage ends when the placenta is expressed 
and the uterus contracted to the size of a closed hand. 

At the beginning of the first stage, the patient 
should have a bath, and her hair braided in two 
braids. Her bowels are emptied by the giving of a 
soap suds enema. After this the external parts are 
washed with bichloride solution, 1-5000, and a pad 
wet with bichloride solution, i-ioooo, or boric acid 
applied. She is as a rule allowed to walk around 
the room during the first stage, which may last from 
ten to twelve hours, and even longer. 

She is best clad at this time in a night gown, warm 
wrapper, and long stockings made of flannel or an old 
blanket, coming well up over the thigh. 

Milk and broths should be given every two hours; 
alcohol and other stimulants must be withheld. 

The patient must be instructed not to bear down 
during the pains of this stage, and to sit or lie down 
when a pain occurs. 

During the second stage the patient must be kept 
Second strictly in bed. The wrapper is removed and a short 
dressing sack put on in its place, the night gown is 
tied up under the arms, and with it a sheet, the end 
of which comes down over the legs covering the 
blanket stockings, which are left on ; it can be folded 
up in the center when necessary. 

The patient usually lies on her back. A strong band 
of muslin around the foot of the bed, with the ends so 
that she can hold them to pull on, will help the patient 
during pains. 



The 



OBSTETRICS 87 

The attendant's hands must be well scrubbed and 
disinfected with bichloride, i-iooo, that she may be 
ready to help the doctor. 

If the doctor does not arrive in time, the attendant, 
taking all antiseptic precautions, must place her hand 
against the head as soon as it appears and hold it 
back during the pains, thus preventing too rapid 
descent. When the head is delivered insert the finger 
into the passage to see if the cord be around the neck, 
if so, pull it carefully over the head. The right hand 
supports the child as it comes, and the other is placed 
on the abdomen and pressed firmly but gently down- 
ward till the child is expelled. One hand must be held 
over the uterus from this time until at least half an 
hour after the placenta is expelled. 

Place the child on its right side between the mother's 
thighs, wipe out its eyes and mouth with swabs wet *^® ^^^^^ 
in boric acid ; place gauze over the mouth and blow 
into it ; if it does not cry, slap it on the back and chest ; 
if the color does not improve the cord will have to be 
tied and cut immediately (it is generally better to wait 
five minutes before doing this) and the child plunged 
into a hot bath. It is rarely necessary to do this, how- 
ever. The cord should be tied tightly with the sterile 
tape about an inch and a half from the navel, and 
again an inch further on; it is then cut (with sterile 
scissors) between the two knots. The baby is rubbed 
with vaseline or olive oil, rolled in the flannel square, 
and a warmed blanket, then put in its crib with at least 



Care of 



88 HOME CARE OF THE SICK 

one hot water bottle until the mother is attended to. 
THe The placenta is generally expressed about fifteen or 

s?age twenty minutes after the birth of the child ; but even 
if it take longer, the cord should not be pulled upon — 
it is better to gently manipuhte the abdomen above 
the uterus, and continue doing this very gently with 
one hand as the placenta comes out, while with the 
other hand twist slowly to aid its coming. Even after 





ENDS OF THE Y BREAST BINDER 

the placenta is expressed, the hand must remain 
pressed downward over the uterus until it feels hard 
and firm. An assistant can in the meantime be wash- 
ing the patient with bichloride, 1-2000, and removing 
the soiled linen. When the uterus is firm and hard a 
binder should be applied, a dressing of sterile gauze 
and a pad being first placed over the vulva; this is 
afterward pinned on to the binder to keep it in place. 
The The binder is best made of unbleached muslin. One 

for a medium size woman should be a yard and a 



Binder 



OBSTETRICS 89 

quarter long and half a yard wide. It should, when 
pinned in place, extend from the border of the ribs 
to below the prominence of the hips, and should be 
made to fit the contour of the body by taking in darts 
over the hips on the upper and lower edges. 

A binder is also used to make compression upon 
the breasts. There are a variety of these, but the Y Binder 




Y BREAST BINDER (a) AND ABDOMINAL 
BINDER (&) IN PLACE 

breast binder originally used in the Boston Lying-in 
Hospital is perhaps the easiest one to manage, and 
has the advantage of leaving the nipples exposed. A 
bandage shaped like a T is made by folding muslin 
lengthwise and pinning it at right angles to another 
strip folded in the same way. The T is then made into 
a Y by making a diagonal fold in the middle of the 
cross piece and fastening the middle of the plait with 
safety pins. 

To apply, dust the surface of breasts with powder, 
draw base of Y beneath the patient's back until apex 



90 HOME CARE OF THE SICK 

of the fork is external to the outer edge of breast. 
. Lift breasts upward and toward each other. Draw 
lower arm of fork snugly across chest beneath breasts, 
the inferior border of this arm extending at least one 
inch below margin of breasts ; the end of arm is 
pinned to end of strap, which has been passed beneath 
back ; the lower border is pinned in the center to 
abdominal binder. The upper arm of fork is then 
drawn across chest above the breasts and pinned like 
the lower to the main strap. 
Hemorrhage Watch for the signs of" hemorrhage already de- 

scribed. Should hemorrhage occur send for the doctor 
immediately ; induce contractions of the uterus by 
grasping the fundus and employing a firm but gentle 
kneading (no doctor would leave the case in your 
charge without showing you exactly how to do this). 
Elevate the foot of the bed, and give a hot douche of 
sterile water, 120° F. Sometimes astringents such as 
vinegar are added to the douche, but unless the case 
is very urgent it is best not to use it without the 
doctor's order. 

The patient must be kept quiet and on her back for 
the first six or seven hours, afterward she can turn on 
her side but should not sit up for at least five days. 
She is generally allowed to sit up on fourteenth day, 
if all discharge has ceased. In no case should the 
usual routine of life be resumed under four weeks. 

The diet is usually liquid for the first twenty-four 
hours, after which all symptoms being normal, the 
patient is allowed almost any easily digested food. 



CARE OF THE CHILD gi 

The dressing and pad should be changed every two 
hours until the discharge diminishes, later every three 
to five, as the case demands. After the third day it is 
usually necessary to change it only after it has been 
reiiioved for the requirements of the patient. These 
dressings must all be sterile and the hands disinfected 
before applying them. If douches are ordered, boil 
the douche nozzle for five minutes before and after use. 

The breasts must be washed with boric acid solution 
before and after nursing. 

THE CARE OF THE CHILD 

After its birth the child's eyes and mouth are 
cleansed with 2 per cent boric acid solution and its 
whole body greased with sweet oil or sterilized vase- 
line. It is then wrapped in warm flannel, put in a crib 
or basket, heated with hot water bags if necessary, and 
covered with a warmed blanket. It can then be left 
until the mother is cared for. Watch the cord care- 
fully as there is danger of hemorrhage. 

The first bath is often given at once, although some 
doctors prefer to have the baby rubbed with oil only Batii 
for the first few days. Before beginning have every- 
thing necessary together — a foot tub containing water, 
100° F., bath thermometer, warm, soh towels, wash 
cloth, castile soap, dusting powder, a dressing for the 
cord, boric acid solution, small squares of gauze, a 
rubber lap protector, two diapers, flannel band, shirt, 
flannel petticoat, and a simple, soft white dress. 



First 



92 HOME CARE OF THE SICK 

The head is first washed, using very Httle soap, 
rinsed and thoroughly dried; then wash behind the 
ears, the crevices of the neck, axilla, joints, and be- 
tween the buttocks and thighs carefully. Only the 
part being bathed should be exposed. The baby is 
now put down into the tub and rinsed, supporting the 
head and back firmly with the left hand and arm. 
Cover the lap protector with flannel apron or warm 
towel and when you lift the baby out, roll this around 
it. Dry by patting; use very little powder and only 
when it is necessary to prevent chafing. Some doctors 
consider it better not to put the baby in the tub until 
after the cord is off. 
jfa^gi The navel is now dressed by cutting a hole with 

Dressing sterile scissors in a piece of sterile gauze, which is 
slipped over the cord and folded about it. The cord is 
laid toward the left side and a pad of sterile absorbent 
cotton put over it. A soft flannel binder holds the pad 
in place and must be put on firmly and smoothly, but 
not too tightly. It is best sewn on with a few large 
stitches. After the bath the baby should be rolled in 
warm flannel and laid on its right side in its crib. 

Nursing The Feeding. The first six weeks the baby should 

nurse every two hours during the day and every three 
hours at night ; afterward this may be changed to every 
three hours during the day and twice at night. These 
hours should be rigidly adhered to. If the baby seems 
thirsty between meals a little plain water may be given. 
The baby's mouth should be washed with 2 per cent 
boric acid solution before and after feeding and also 
the mother's nipples. 



FOOD FOR THE SICK 93 

When for any reason it is impossible for the mother 
to nurse the child, great care must be exercised in the 
preparation of its food. First the bottle and nipples 
must be thoroughly cleansed immediately after each 
feeding by rinsing in cold water, then washing in hot 
water and soap suds and rinsing in hot water. The 
bottle is kept turned upside down and the nipples in 
a 2 per cent solution of boric acid. Both bottle and 
nipples should be boiled for five minutes twice a day. 

Every doctor has his own formula for prepared 
milk, but whatever the preparation used it is best 
pasteurized if not above suspicion. 

FOOD FOR THE SICK 

In many diseases, especially those accompanied by 
fever, the powers of digestion are much impaired. For 
this, as well as other reasons, it is necessary that all 
food given should be in a liquid form. Milk, except 
under certain conditions, is at such times considered 
the best food, as it contains in a dilute form all the 
constituents of the solids, namely : albumen, fat, sugar, 
the inorganic salts of lime and potash, and water. 

If curds appear in the stools, or vomiting ensues, 
it shows that the milk is not being properly digested. 
This difficulty may often be overcome by diluting it 
with seltzer or other effervescent water, by the addi- 
tion of lime water or bicarbonate of soda (ten grains 
to a pint), or by peptonizing the milk. (The recipe 
for the latter will be found at the end of the section.) 



Milk 



94 



HOME CARE OF THE SICK 



Amount 

and 

Frequency 



Feeding 
Cups 



A good substitute for milk is white of egg, beaten 
to a froth, diluted with an equal quantity of water, 
and flavored with lemon juice. 

Beef tea and broths contain very little nourishment, 
and should, therefore, be given only occasionally, for 
a change. 

Patients on fluid diet should, as a rule, be given six 
ounces every two hours, or half the quantity every 
hour. Of course there are times — as after operation, 
or when the patient is nauseated — when less must be 
given. 

When a patient is on liquid diet it is especially im- 
perative to give her nourishment at stated times and 
regular intervals. In giving see that it is taken very 
slowly. 

As a rule, when a patient is sick enough to be on 
fluid diet it is necessary for her to maintain the re- 
cumbent position, even while drinking, and there are 
several devices to facilitate this. There is the old- 
fashioned feeder with the spout, but the drinking tube 
or ''ideal glass" are preferable. When raising the 
head slip the arm under the pillow ; take care not to 
throw the head forward, and by so doing make it 
difficult to swallow. Never bring a glass to the patient 
in your hand, but on a small tray or plate, and with 
it a napkin to fold under the patient's chin and pre- 
vent drops soiling the sheet. 

When a patient is on milk diet her mouth should be 
washed out after every feeding, with listerine or boric 



Food 



FOOD FOR THE SICK 95 

acid, otherwise it will soon become coated and sore. 
Directions for doing this were given in the section 
on the care of the teeth. 

A convalescent patient should be given solid food solid 
only by degrees, beginning with the so-called soft diet, 
which includes broths, strained vegetable soups, soft 
cooked eggs, milk toast, junkets, custard, jellies, and 
raw beef sandwiches. Then comes "light diet," which 
means the addition to the "soft diet" of underdone 
steak, chops, chicken, baked potatoes, and farinaceous 
puddings. 

Pastry and all rich or highly seasoned food should 
be avoided until the patient has, in every respect, re- 
sumed her usual routine of life. 

In diseases such as rheumatism, Bright's disease, 
diabetes, dyspepsia, etc., where fever is not the most ^^e* 
important symptom, but where the effect of certain 
foods must be taken into account, a special diet is 
prescribed. As the patient's general condition must 
be considered in the prescribing of such, I think 
it wise to make only a few general remarks on the 
subject, as a great deal of harm is frequently done by 
following set rules for medication and food, by those 
who are unable to recognize symptoms contra-indi- 
cating their use. 

In many forms of febrile disease, as for instance 
tuberculosis, light diet can be given even while there 
is fever, nourishing food being a most important item 
in the treatment. 



Special 



96 HOME CARE OF THE SICK 

In diabetes, sugar and starchy foods, most fruits, 
and alcoholic drinks must be avoided. Gluten bread 
should be used, and that not too fresh; saccharine 
should be used instead of sugar for sweetening not 
only tea and coffee, etc., but also in cooking. Fresh 
milk should not be taken, but buttermilk and koumyss 
are allowed. 

In rheumatism and gout, as in diabetes, all sweeten- 
ing should be done with saccharine, and sweets of all 
kinds are prohibited, also pastry, puddings, jellies, 
pork, veal, and all fried meats. Fruit except straw- 
berries and bananas, is allowed. 




TRAY WITH FEET 

Dainty ^00 great strcss cannot be laid on the necessity for 
Serving ^ dainty serving of the patient's meals. They should 
be either very hot or perfectly cold, as the case re- 
quires. Have clean napkins, spotless china, and shin- 
ing silver and glass. Be careful in carrying the tray 
not to spill any of the fluids, and, as has been said 
before, do not have too much on the tray at a time. 
Furthermore, that the patient may thoroughly enjoy 
the meal, it is necessary that she should be perfectly 



FOOD FOR THE SICK 



97 



comfortable. Therefore, before bringing in the tray, 
wash her face and hands, shake up the pillows, and 
decide where it is best to set the tray. If there is no 
bedside table or tray w4th feet, it is a good plan to 
have two blocks of wood to put on each side of the 
patient. They should be about the width of the tray, 
and high enough to hold it off the patient's chest. 
Magazines will answer the purpose if the blocks can- 
not be obtained. Always protect the night-gown and 
bed clothes with a towel or table napkin. 



EECIPES 

Milk 

In warming milk for drinking never allow it to 
boil, and always keep it covered. It is the coagula- 
tion of the casein by boiling, and the evaporation of 
certain gases, that renders it indigestible. 

Brandy Milk with Egg 

Beat one tgg with one tablespoonful of sugar; add 
two tablespoonfuls of brandy and a cup of cold milk. 

Koumyss 

I qt. perfectly fresh milk. 

I -5th of a 2-cent cake of Fleischmann's yeast. 

I tablespoonful of sugar. 

Dissolve the yeast in a little water ; mix it with the 
sugar and milk. Put the mixture into strong bottles ; 
cork them with tightly fitting stoppers; tie down se- 
curely with stout twine. Shake the bottles for a full 



Never 
Boil 



Five 
Days 
Required 



98 HOME CARE OF THE SICK 

minute; place them on end in a refrigerator; at the 
end of three days lay them on their sides; turn them 
occasionally. Five days will be required to perfect 
fermentation. Kept in the refrigerator and well corked 
koumyss will keep indefinitely. 

Milk Lemonade 

I tablespoonful sugar. 

I cup boiling water. 

%. cup lemon juice. 
" 34 cup sherry. 

i^ cups cold milk. 

Pour the boiling water over the sugar; add the 
lemon juice and sherry. Stir it until the sugar dis- 
solves ; add the cold milk ; stir again until the milk 
curdles ; strain through muslin. 

Milk Punch 

Sweeten i cup of milk with i teaspoonful of sugar ; 
stir in 2 tablespoonfuls of brandy ; beat with egg- 
beater ; pour into glass and grate nutmeg over the top. 

Milk Rennet 

_ Stir I teaspoonful of rennet and 2 teaspoonfuls of 

^CMna sherry together with i teaspoonful of sugar. Heat i 
pint of milk until it is exactly ioo° F. ; pour into bowl 
containing rennet and wine ; stir quickly and only 
enough to mix ingredients ; grate nutmeg over the top, 
and set on ice till solid. 



• FOOD FOR THE SICK 99 

Peptonized Milk 

Mix 5 grains of pancreatic extract and 15 of soda 
bicarbonate with cold milk ; warm a pint of milk and 
add; stir well and put on ice to cool. 

Barley Gruel 

Mix I tablespoonful of Robinson's barley-flour with 
half a teaspoonful of sugar ; pour over this a cup of 
boiling water ; boil ten minutes ; add a cup of milk ; 
bring to boiling point ; serve very hot. 

Arrowroot Gruel 

Mix half a tablespoonful of arrowroot with i salt- 
spoonful of salt, half a teaspoonful of sugar, wet with 
2 tablespoonfuls of cold water; pour on a cup of boil- 
ing water, stirring constantly. Boil for twenty min- 
utes ; add the milk, and bring to boiling point ; strain ; 
serve immediately. A little port wine is often added. 

Oatmeal Gruel 

Mix 2 tablespoonfuls of oatmeal, half a teaspoonful 
of sugar and a saltspoonful of salt. Pour this slowly 
into boiling water; cook in a saucepan for thirty 
minutes, or, preferably, in a double boiler for two 
hours ; strain ; add the milk, and bring to boiling 
point. 

Cracker Gruel 

Mix 2 tablespoonfuls of cracker crumbs with half a 
saltspoonful of salt and half a teaspoonful of sugar. 
Pour over this a cup of boiling water, add one cup of 
milk and simmer for tw^o minutes. 

1.0FC. 



Gruels 



100 HOME CARE OF THE SICK 

Beef Tea 
Cut two pounds of round steak into half-inch 
squares ; put into double boiler and add one quart of 
water; let stand one hour, then place over fire and let 
simmer two hours ; flavor to taste. 

Chicken Broth 

Broths Cut Up a fowl (which has been properly cleaned) 

into small pieces ; add a quart or a quart and a half of 
cold water, according to size of fowl. Let stand for 
one hour and simmer for two hours, then boil slightly 
for one. Strain it, remove fat, and flavor to taste. 

Mutton Broth 

Cut one pound of loin or neck of mutton into small 
pieces; put with one teaspoonful of chopped onion 
into one quart of water. Let stand one hour, and 
simmer three ; strain ; let cool ; then remove the fat 
which rises to the top. Heat when ready to serve; 
season with salt and white pepper. 

Flaxseed Tea 

Drinks Boil one tablespoonful of flaxseed in a pint of water 

for one hour ; strain ; add one tablespoonful of lemon 
juice and one tablespoonful of sugar; serve either hot 
or cold. The loss by evaporation should be made good 
from time to time, so that at the end of the cooking 
there shall be one pint of tea. 

Coffee 

For every cup of water use a heaped tablespoonful 
of coffee. Soak the coffee for several hours in cold 



FOOD FOR THE SICK loi 

water; bring to boiling point and let simmer for a 
few minutes ; let stand on the back of the stove for a 
minute to settle before serving. 

Caudle 

To a cupful of thin oatmeal gruel add a tablespoonful 
of sherry, one Ggg well beaten, sugar to taste; it can 
be served either hot or cold. 

Toast Water 

Toast till dry three slices of bread an inch thick; 
break into small pieces ; add a pint of cold water ; soak 
for an hour; strain, and squeeze the water out of the 
toast with the back of a spoon. Serve cold ; if desired 
a little cream and sugar may be added. 

Barley Water 

Boil one tablespoonful of barley flour, a teaspoonful 
of sugar, a saltspoonful of salt and a quart of water 
together for fifteen minutes ; strain ; it can be flavored 
either with lemon juice of port or sherry wine. 

Rice Water 

This is made in the same manner as barley water, 
except that two tablespoonfuls of rice will be required 
to a quart of water. 

Oyster Soup 

Heat a cup of milk; add two tablespoonfuls of 
cracker crumbs, a saltspoonful of salt, a sprinkle of 
pepper, a fourth of a teaspoonful of butter ; when this 
is warm through add a cup of fresh oysters and juice; 



102 HOME CARE OF THE SICK 

allow to simmer for about two minutes, or till the gills 
of the oysters curl. 

Milk Toast 

Toast three slices of bread a delicate brown ; butter 

them and put them into a covered dish. Cover them 

with milk which has been brought almost to boiling 

point. 

Soft Custard 

Beat together the yolks of two eggs, a saltspoonful 
of salt, and two tablespoonfuls of sugar; add this 
slowly to a pint of milk which has been brought to 
boiling point ; boil three minutes. Flavor with vanilla 
or sherry wine ; serve cold. 

Egg-nog 

Egg Break one egg into a bowl ; add one saltspoon- 

ful of salt and two teaspoonfuls of sugar; beat 
until light ; add one cup of milk, one or two tablespoon- 
fuls of good brandy or whisky ; serve immediately. 

Sherry and Egg 

Break an tgg into a bowl ; add a teaspoonful of 
sugar ; beat the two together until well mixed ; add 
two tablespoonfuls of sherry wine and a fourth of a 
cup of cold water ; mix thoroughly ; strain, and serve 
immediately. 

Scrambled Eggs 

Beat two eggs, a saltspoonful of salt, a sprinkle of 
white pepper, with a Dover egg-beater, until quite 
light ; add four tablespoonfuls of sweet cream or milk ; 



Dishes 



FOOD FOR THE SICK 103 

turn the mixture into a double boiler ; cook, stirring 
constantly until the albumen is coagulated. 

Foamy Omelet 

Separate the yolks from the whites of two eggs. To 
the yolks add a saltspoonful of salt and one-fourth of 
a saltspoonful of pepper. Beat with a Dover egg- 
beater imtil light; add two tablespoonfuls of milk. 
Beat the whites until fairly stiff, and fold them into 
the yolk ; pour the mixture into a hot buttered omelet 
pan ; cook for about two minutes ; put into the oven for 
one minute to cook the upper surface. 

Egg Cream 

Separate the yolks of two eggs from the whites ; 
add two tablespoonfuls of sugar to the yolks ; beat 
until well mixed; add the juice and grated rind of half 
a lemon ; place the bowl in a dish of boiling water on 
the fire ; Stir slowly until the mixture begins to thicken ; 
add the beaten whites of eggs, and stir for two minutes. 
Serve cold. 

Poached Eggs 

Pour some boiling water into a small saucepan ; salt 
it and add half a teaspoonful of vinegar ; break a fresh 
egg gently into this. As soon as the white is firm lift 
out the egg with a skimmer, and put on crustless but- 
tered toast. 

Soft Cooked Eggs 

Never boil eggs for the sick. Boil enough water to 
cover the eggs ; put them in ; remove the saucepan to 



Jellies 



104 HOME CARE OF THE SICK 

the back of the stove where the water will not lose its 
warmth too soon, and let them stand ten minutes. 

Jellies 

The order for making nearly all jeUies is as follows: 
The gelatine is hydrated, or softened, by soaking in the 
cold water for half an hour. The boiling water, sugar 
and flavoring are then added, in the given order. 
Strain and cool. 

Lemon Jelly 

%. box of gelatine. 

% cup of cold water. 

lyi cups of boiling water. 

^ cup of sugar. 

J4 cup of lemon juice. 

I tablespoonful of brandy. 

Orange Jelly 

% box of gelatine. 

J4 cup of cold water. 

^ cup of boiling water. 

^ cup of sugar. 

I cup of orange juice. 

Juice of half a lemon. 

As soon as the latter begins to stiffen it can be 
whipped till stiff, making orange sponge, which, 
served with custard, makes a very dainty dish. 

Velvet Cream 

Soak }i box of gelatine in ^ cup of cold water for 
half an hour ; then pour in ^ cup of sherry wine ; set 



FOOD FOR THE SICK 105 

the bowl in a dish of boiling water over the fire. When 
the gelatine is dissolved add a teaspoonful of lemon 
juice and ^ a cup of sugar ; strain ; set the bowl in a 
di^h of ice and water to cool. As soon as it begins to 
thicken turn in the cream. Stir this until it also thick- 
ens ; mould and put on ice. Serve with cream. 

Wine Jelly 

}i box of gelatine. 

j4 cup of cold water. 

i}i cups of boiling water. 

^ cup of sugar. 

y^ a square inch cinnamon. 

I clove. 

y^ cup of sherry wine. 

Coffee Jelly 

% box gelatine. 
}i cup of cold water. 
I cup of boiling water. 
^2 cup of strong cofifee. 
^ a teaspoonful of vanilla. 
3^ a cup of sugar. 

EMERGENCIES. FIRST AID TO THE INJURED 

In all emergencies one of the chief requisites is 
coolness. Do not get excited, or you will be perfectly 
useless. When the doctor's services are necessary send 
him a written statement of the case, that he may come 
prepared with the proper appliances. Severe injury 



the Air 



io6 HOME CARE OF THE SICK 

of any kind is apt to be followed by that complete 
prostration of the vital powers known as "shock." 
Therefore, after such, the patient should be put into a 
warm bed, and hot water bags applied to the feet and 
over the heart. 

Exclude • Scalds and Burns. In the treatment of scalds and 
burfis the first object is to allay the pain by excluding 
the air. This is done best by the application of clean, 
soft, white linen or cotton cloths wrung out in a solu- 
tion made by dissolving a tablespoonful of bicarbonate 
of soda (baking soda) in a pint of boiled water. This 
treatment can be continued for the first few days; 
afterwards boric acid ointment spread on lint or soft 
sterile cotton will be found healing. Do not try to 
treat a burn of any extent without a doctor's advice, 
as many complications are likely to ensue. In fact, in 
such cases, it is always best to send for the doctor 
immediately, as many people have died from shock 
after comparatively small burns. 

Frost Bites. Rub with snow, or cloths wrung out in 
ice-water. The rubbing must be very light at first, and 
the patient kept away from the heat. 

Syncope or Fainting. Place the head lower than the 
feet if possible; give plenty of fresh air. Ammonia 
may be given by inhalation, but it should not be very 
strong, as it is irritating to the bronchial tubes. If 
these measures are not successful treat as in case of 
shock. 



EMERGENCIES 107 

Shock. Put the patient into a warm bed ; undress 
and roll in blankets ; apply heat to the extremities and 
over the heart; raise the foot of the bed, so that the 
patient's head will be considerably lower than the feet. 
If possible avoid giving stimulation till the doctor 
arrives ; if, however, he cannot be found, and the case 
is urgent, give a rectal injection of whisky i oz., 
water 5 ozs. (105° F.), salt 5 grains. Coffee may be 
used instead of water and salt. 

Epilepsy. Loosen all clothing; put something be- 
tween the teeth to prevent the tongue being bitten; 
have the head on a level with the feet; give plenty 
of fresh air but no stimulants. 

Drozvning. In cases of drowning where a person Is 
apparently lifeless, efforts to restore life should be 
commenced at once by loosening all tight clothing 
around neck, chest, and waist. Turn the patient over 
quickly on his face, raising the body slightly at the 
waist to allow any water in the throat or air passages 
to run out. Wrap a handkerchief or a towel around 
the forefinger and gently cleanse the mouth. All this 
should take only a minute or two. Place the person 
upon his back with a folded coat or a firm pad of any 
kind under his shoulders to raise them a little. Be 
careful that the tongue does not slip back and shut 
off the air from the trachea. If it shows any tendency 
to do so, have some one hold it out, or tie a hand" 
kerchief around it and then around the neck. 



io8 



HOME CARE OF THE SICK 



Artificial 
Bespiration 



Now artificial respiration should be produced until 
the natural breathing is restored. To do this kneel 




ARTIFICIAL RESPIRATION (First Movement) 

behind the patient and grasping his arms just below 
the elbows, draw them slowly upward above his head 
until they nearly touch. Give a firm pull for a mo- 
ment. This movement tends to fill the lungs with air 
by raising the ribs and increasing the chest cavity. 




ARTIFICIAL RESPIRATION (Second Movement) 

Then carry the arms slowly back to the sides of the 
body and press them against the ribs. This movement 
forces out the air which was drawn into the lungs and 
makes artificially a complete respiration. These two 



EMERGENCIES 



109 



movements should be repeated slowly and steadily 
about sixteen times in a minute, until respiration takes 
place naturally. This may require an hour or more. 

. Asphyxiation, Caused by Gas, Smoke, etc. Remove 
the patient into the fresh air, loosen the clothing, 
throw cold water in the face, neck, and chest ; apply 
heat to the feet and over the heart. If respiration is 




EXPELLING THE AIR (Third Movement) 

shallow, artificial respiration should be performed, and, 
if necessary, treat as for shock. 

Contusions, or Bruises, are best treated by rest and 
cold applications. 

Wounds. When there is a cut, the first procedure, 
provided there is no hemorrhage, is to wash out the 
wound well with bichloride, 1-5000, and bind it up 
with sterile gauze. A wound will heal without the 
formation of pus if all bacteria are killed or kept out. 
When the cut is long, or the ends of the wound do not 
come together well, the doctor should be summoned, 
as putting in a few stitches may prevent an unsightly 



Guarding 
Against 
Blood 
Poisoning 



no HOME CARE OF THE SICK 

scar. (Having bichloride and sterile gauze always in 
the house would save many a case of blood poison, 
Tourni uet infected fingers, etc.) Collodion is useful in keeping 
bacteria out of small cuts and in applying absorbent 
cotton over wounds in places where bandages cannot 
be used. 

Hemorrhage. Elevate the afifected part ; make com- 
pression over the wound by applying clean compresses 
and bandaging tightly. If this does not check it, and 
you do not know the course of the arteries well enough 




Manner of compressing ah artery with a handkerchief and stick. 

to make compression upon the required one, tie on a 
bandage very tightly above the wound. A pencil or a 
piece of wood stuck under this, and turned around, 
will act as a tourniquet. When possible, in addition 
to this it is always better to place a hard pad over the 
course of the artery. A doctor's aid must be sought 
immediately, for if the blood is shut off in this manner 
longer than an hour gangrene is likely to set in. 



EMERGENCIES 



Epistaxis (bleeding from the nose). Make the pa- 
tient stand or sit erect ; throw the head back and 
elevate the arms, while you apply ice or ice-cold com- 
presses to the forehead and back of neck. If the 
bleeding still continues the nostrils should be syringed 
with salt and water, ice cold. Avoid blowing the nose, 
and so disturbing the formation of clots. 

Hemorrhage from the Lungs. Keep the patient 
quiet, give crushed ice, and put ice-cap on chest. Salt 
solution made by dissolving a teaspoonful of salt in a 
small cup of water may also be given. 

Sprains occur most frequently at the wrist and ankle 
joint. Soak the affected part in hot water, or apply 
hot compresses. The joint should then be supported 
by strapping, and given moderate use. A surgeon 
should do the strapping, for if it- is not properly done 
serious trouble may result. 

Fractures. It is a mistaken impression that a frac- 
ture must be set immediately. It will do less harm 
for it to be left a day or two without splints than for 
them to be applied awkwardly. Handle the injured 
limb as little as possible, and keep the patient quiet 
until a competent surgeon can be obtained. Temporary 
splints made of pasteboard, shingles, etc., may be 
bound on to prevent the spasmodic twitching of the 
muscles ; cold or hot compresses applied will keep 
down the swelling and relieve tbe pain. 

Dislocations should be reduced as soon as possible, 
but only a surgeon can do this properly. 



Cold 
Applications 



Strapping 



Fractures 
Need 

Not Be Set 
At Once 



But Water 



112 HOME LAKE UE THE blLK 

FOREIGN BODIES IN THE EYE, EAR, NOSE, THROAT 

The Eye. If anything gets under the lower lid, draw 
the lid down by the lashes, direct the patient to turn 
the eyeball toward the nose, and the offending body 
can then be wiped out with a soft handkerchief. If it 
is under the upper lid, this can be turned up over a 
thin pencil or knitting needle, and treated in the same 
way, except that the patient is directed to look down. 
Always wipe the eye towards the nose. If the particle 
is imbedded in the surface of the eyeball a surgeon 
must be notified immediately ; do not make any effort 
to get it out. 
Use Nothing Foreign Body in the Ear. Unless the object is 

something that will swell with moisture, syringe gently 
with warm water, taking care not to close the opening 
with the nozzle of the syringe. If this method fails go 
to a doctor; any unskilled effort to poke or probe the 
object out is likely to result in permanent injury to 
the ear. 

The Nose. When a foreign body is in the nostril 
make the patient take a full breath, then close the 
mouth and the other nostril firmly — the air will prob- 
ably expel the obstruction. If this fails, and the object 
is in sight, compress the nostrils above and hook it 
out with a hairpin or piece of bent wire. 

A Foreign Body in the Throat may be hooked out 
in the same way ; if not, a piece of bread should be 
swallowed ; this may carry down the obstruction. Do 
not give purgative medicine, as is often done, but 



- POISONS AND ANTIDOTES 113 

rather plenty of solid food, especially potatoes and 
bread. 

A Foreign Body in the Windpipe will usually be 
dislodged by the coughing which its presence excites; 
if not, a blow on the back, or, in the case of a child, 
holding it up by the feet and administering a succes- 
sion of blows between the shoulders will generally 
produce the desired effect. 

POISONS AND ANTIDOTES 

The treatment has three objects in view: to re- Give an 
move the poisonous substance, neutralize its further Ar^once 
action, and remedy the ill effects already produced. 
An emetic is the first consideration. A tablespoonful 
of salt or mustard stirred into a glass of lukewarm 
water will usually prove effective. This dose should be 
repeated three or four times. An enema should also 
be given, the patient kept warm, and, as soon as vomit- 
ing ceases, the chemical antidote given. 

The following table of the chemical antidotes and 
further treatment of the most common poisons should 
be learned and remembered. 

Carbolic Acid. Lime water and milk, equal parts, 
a pint to a pint and a half. Atropine and heart stimu- 
lants, such as whisky and strychnine, may be required, 
given hypodermically. 

Nitric or Oxalic Acid. Chalk or whiting, the plaster 
from walls, milk and lime water. Give whichever can 
be obtained quickest. 



114 HOME CARE OF THE SICK 

Ammonia. Vinegar or lemon juice, followed by 
castor or olive oil. 

Arsenic. The best antidote is tincture of iron, di- 
luted with v/ater, and either baking or washing soda. 
Lacking this, or till it can be obtained, give milk and 
white of Qgg, or flour and water. 

Aconite or Belladonna. Strong, hot coffee. Give 
artificial respiration if necessary. 

Bichloride of Mercury (corrosive sublimate). White 
of egg — white of two eggs to a pint of water. 

Calomel. The same as bichloride of mercury. 

Opium. Strong, hot coffee. Keep the patient 
awake, using- artificial respiration when necessary; 
permanganate of potash and tannic acid are the best 
chemical antidotes, but they can rarely be obtained 
in a hurry. 

BANDAGES AND BANDAGING. 

Materials '^^^ materials most commonly used for making 

bandages are either unbleached muslin or gauze. Mus- 
lin bandages are best wdien necessary to keep a splint 
in place, or make firm pressure. Gauzes are infinitely 
preferable when the object is only to keep a surgical 
dressing in position; they adapt themselves more 
neatly to the part, and are much cooler. 

Bandages should be six to eight yards long; they 
vary in width from one inch to four ; one inch for 
finger bandages, two for hands and feet, two and a 



BANDAGING 



IIS 



half to three for head and arms, three to four for legs, 
spicas, etc. 

The three fundamental .forms of bandaging are : the 
spiral, reverse, and figure eight. 

The figure eight principle is the one most used, and 
is the easiest method to learn. It is made by turning 
the bandage round the limb in the form of the figure 
8, each figure being higher than the preceding one, 
but overlapping it one-third of its width. A bandage 
must lie smoothly without wrinkles, making an even 
but not too severe pressure. It must not be loose 
enough to slip, yet not tight enough to be painful or 
impede the circulation. 

When finishing a bandage always put the pin on the 
outer side of a limb, and in all cases where it will 
least interfere with the patient's comfort. Safety pins 
should always be used. 

In bandaging a limb begin at the extremity, and 
work upwards from left to right. Hold the bandage 
with the roll side upward. 

To bandage a foot start the free end of the bandage 
at the instep, make a turn around the base of the toes, 
carry the bandage diagonally over the foot, across the 
point of the heel, and back from the other side till it 
coincides with the first turn. Cover this, and carry a 
second turn around the heel, half an inch higher than 
the first. Continue making alternate turns under the 
sole and behind the heel, crossing over the instep, until 
the foot is covered. Finish with a couple of circular 



Figure 

Eight 

Bandage 



Finishing 



Foot 
Bandage 



Ji6 



HOME CARE OF THE SICK 



Leg 
Bandage 



turns around the ankle, or, if desired, continue up the 
leg. 

The beginning- of the leg bandage is placed obliquely 
across the leg above the ankle ; a circular turn keeps 
it in place ; then the bandage is inclined up the leg, 
and a turn taken around it. It is then brought down- 
ward, and another turn taken around the ankle. Suc- 






FIGURE 8 OF THE FOOT. 

cessive turns are to be made, each one higher than 
the preceding, till the entire limb is covered. 

To bandage a hand begin at the top of the first 
finger and cover it by a succession of oblique circular 
turns, or figures of eight, to its base. Then make a 
turn around the wrist to keep these from slipping, and 
return to the root of the second finger. Lead the 



BANDAGING 



117 



bandage by one or two spirals to the top of this, then 
proceed down it, as upon the first finger, concluding 
with another turn upon the wrist. Cover each finger 
successively in the same way ; then take a wider 
bandage, start at the back of the 
hand and wind it around the base 
of the fingers, carry it' obliquely 
across the back of the hand around 
the wrist, back to the further side, 
and again around the palm. Con- 
tinue these turns alternately till the 
hand is covered. The arm is ban- 
daged in the same manner as the 
leg. 

When it is only necessary to cover 
the forehead or back of the head the 
figure-of-eight is all that is required. Figure 8 of the Leg 
Start the bandage over the ear, carry it across the 
eyebrows and around the back of the head as high as 
possible. Continue to wind it round thus, making 





FIGURE 8 OF THE ARM. 

each turn a little higher in the front, and lower in the 
back, until you have covered as much surface as 
required. When the whole head needs covering 
the capeline is better. This is put on by a 



Forehead or 
Back of Head 



The 
Capeline 



ii8 



HOME CARE OF THE SICK 



double roller (join two bandages by rolling). Stand 
behind the patient, and, taking one roll in each hand, 
begin low on the forehead and carry them round the 
head, far down on the nape of the neck ; then transfer 
the bandage in the left hand to the one in the right, 
and continue it round, while the other is folded over 
at right angles with it, and brought across the top of 
the head to the front. Here it meets the other and 
crosses it again, running backward and overlapping 
the former folds. These turns are continued until the 




Four Tailed 
Bandages 



Bandage of the Hand 

whole head is covered, one bandage going round and 
round it, and the other going back and forth across 
it; all the folds leading from the front of the head to 
the back should be on the left of the middle, while 
those leading toward the front should be on the right. 
Finish with a circular turn around the head; fasten 
with a safety pin in front. 

The tailed bandages are often found very convenient, 
especially for keeping poultices and the like in posi- 
tion. 

The four tailed bandage of the head is made from 
a piece of muslin eight inches wide and long enough 



BANDAGING 119 

to go over the scalp and tie under the chin. It is torn 
from each extremity to within three or four inches 
of the middle. The body of the bandage is placed on 





FIGURE 8 OF THE HEAD 

the top of the head, the two posterior tails tied under 
the chin, and the two anterior ones around the back of 





THE CAPELINE 

the neck. If it is desired to cover the front of the 
head the body of the bandage is placed at this point, 
the two anterior tails are fastened at the back of the 
head, and the two posterior ones down under the jaw. 



120 



HOME CARE OF THE SICK 



A four tailed bandage for the knee is made by 
splitting a strip of muslin at each end, to within two 
or three inches of the center. Place the body of the 





FOUR-TAILED BANDAGE OF THE HEAD 

bandage over the knee, carry the tails under the knee, 
cross them so that the lower ones will come above the 
joint, and the upper ones below; bring 
them around, and tie in front. 
icuitetufc A scultetus, or many tailed, is used 

on the abdomen, to obtain pressure, to 
keep a surgical dressing or poultice in 
place, etc. To make it take four or five 
strips three inches wide and a yard and 
a quarter to a yard and a half long, sew 
them together in the center for a quar- 
ter of a yard, each one overlapping the 
other by two-thirds of its width. To 
apply, pass the bandage under the pa- 
tient, so that the sewed part is under 
her back; fold the strips alternately 

^ : Four Tailed Band 

over the abdomen, from below upward, age of the Knee 




BANDAGING 



121 



To make a sling take a square yard of muslin and 
cut it across diagonally ; this makes two slings. When 
the fore-arm is injured its whole extent should be 
supported equally. Put it in the center of the sling; 
carry its outer end around the neck on the side of the 
injured arm, and the end between the arm and the 



Slings 





SLINGS FOR LOWER AND UPPER ARMS 

chest around the other side, tying them at the back. 
The third end is brought around the elbow and fas- 
tened in front. 

If the injury is of the upper arm the sling should 
support the wrist only, making no pressure on the 
elbow. Turn the hand palm inward, fold the apex 
of the bandage in place, the arm just above the wrist 
in the center of the sling, cross the ends and tie them 
around the neck. 

The student should practice the various bandages 
and slings described on some member of the family 
or a friend. Some little experience is required before 
they can be applied securely and neatly. The illustra- 
tions will help to make the matter clear. 



Sling for 
Upper Arm 



HOME CARE OF THE SICK 

BIBLIOGRAPHY 

Food and Cookery for the Sick and Convalescent ($1.50). 

Fannie M. Farmer. 
Food for the Sick ($1.00). Edward C. French. 
Home Nursing ($1.00). Eveleen Harrison. 
Nursing ($2.00). Isabel A. Hampton. 

Practical Normal Histology ($1.25). T. Mitchell Prudden. 
Practical Points in Nursing ($1.75). Emily A. N. Stoney. 
Text Book of Nursing ($i.75)- Clara Week Shaw. 

MAGAZINES 

The American Journal of Nursing. 
The Trained Nurse. 

Note. — For the convenience of students the School will purchase and 
forward any of the above books on receipt of the price given. 



TEST QUESTIONS 

The following questions constitute the 'Vritten reci- 
tation" which the regular members of the A. S. H. E. 
answer in writing and send in for the correction and 
comment of the instructor. They are intended to 
emphasize and fix in the memory the most important 
points in the lesson. 



HOME CARE OF THE SICK 

PART II 



Read Carefully. Place your name and address on the 
first sheet of the test. Use a light grade of paper and write 
on one side of the sheet only. Do not copy answers from 
the lesson paper. Use your own words, so that your in- 
structor may know that you understand the subject. Carry 
out the directio7is given in the text^ if possible, before 
answering the questions. 



1. How are infectious and contagious diseases alike? 

How do they differ? Name some of each. 

2. What precautionary measures should be taken 

with typhoid fever? With consumption? 

3. What are the rules when isolation is necessary? 

4. What precautionary measures should be taken 

by the attendant while nursing in a contagious 
disease? 

5. How disinfect (a) the patient, (b) the room, 

(c) the furnishings at the termination of a 
contagious disease? 

6. Why are the many precautions taken in surgical 

operations and in childbirth? 

7. What can you say of diet for the sick? Why 

should special care be taken in serving? 

8. What should the medicine closet contain in prepa- 

ration for emergencies and accidents? 
.9. How would you treat a scald or burn? PYost 

bite? A wound? 
10. What is shock and how should this condition be 

treated ? 



HOME CARE OF THE SICK 

11. Why should written directions be sent to the 

doctor in accidents? 

12. What would you do for a sprain? Fractures? 

In case of hemorrhage from an arm or leg? 

13. What should be done at once for one who has 

fainted? One apparently drowned? Asphyxi- 
ated ? 

14. Give the rules of hygiene in pregnancy. 

15. Name some of the things to be provided for child- 

birth. How should the room be prepared? 

16. Describe the stages of labor. 

17. What should be done if the doctor does not ar- 

rive in time? 

18. How should the child be cared for directly after 

birth? 

19. How would you remove a foreign body from the 

eye? Ear? Nose? Throat? 

20. In case of poisoning, what objects has the treat- 

ment in view? 

21. What would you do for carbolic acid poisoning? 

Bichloride of mercury? Arsenic? Opium? 

22. Of what material are bandages made? How 

should they be applied and fastened? 

23. Bandage a foot as shown in the illustration and 

then describe the process. 

24. Try some of the other bandages described and 

report. 

25. Make and adjust a sling for the forearm. When 

should it be used ? 

26. What questions would you like to ask in connec- 

tion with these lessons ? Tell of any experience 
that you may have had in nursing and of meth- 
ods that were helpful. 

Note. — After completing the test sign your full name. 



PREVENTABLE DISEASES 



CONSUMPTION 

Circular of Ixformation for Persons Suffering From 

Pulmonary Disease, and for Others 

LiviN^'G IN the Same House 

Issued by the National Association for the Study and Prevention of Tuber- 
culosis, 105 East Twenty-second Street, New York. 

GENERAL CONSIDERATIONS 

Several diseases of the lungs are spread from person 
to person by the coughing and spitting of those 
affected. Among these diseases are Consumption, 
Influenza or Grippe, Bronchitis, Common Colds, and 
Pneumonia. Those who suffer with any of these 
affections cannot help coughing and spitting, but they 
can cough and spit in such a way as to avoid com- 
municating their disease to others. 

COUGHING 

The infective agent, or "germ," is contained in the 
material raised by coughing. Very small bits of 
such material may contain large numbers of these 
germs. Most persons, when coughing, instinctively 
hold the hand over the mouth. That is not a very 
bad habit, for you may at least know what you have 
done. You have possibly infected your hand, but 
have not prevented the act of coughing from, scatter- 

125 



126 HOME CARE OF THE SICK 

ing about you fine particles of saliva, which may 
contain bacilli. It is better to hold a handkerchief* 
over your mouth, and, when done coughing, to put 
the handkerchief at once into the pocket — into the 
handkerchief pocket, into which a small paper bag 
has been previously placed to prevent contamination 
of the pocket, and which can be burned when con- 
venient. If accidentally you cough anything, no 
matter how little, into your hand, you should clean 
your hand very carefully. If one has tuberculosis 
or pneumonia it is most important, indeed it is almost 
vital to persons around, to avoid cantaminating the 
room with materials coughed up. 

Persons subject to prolonged attacks of coughing 
should, if possible, retire to a convenient place until 
the fit is over, and under all circumstances should be 
careful that the fine spray coughed up is all caught 
upon some material which can be completely and 
promptly destroyed. 

The material expelled by coughing is, as a rule, 
small in amount, and consists of minute droplets, but 
its power to infect is not to be judged by the small 
amount or by the minuteness of its particles, for the 
tiny germs are plants, each of them capable of rapid 
growth when transferred to the lungs of another 
person. 



*NoTE. — The use of handkerchiefs for this purpose might well be dis- 
couraged, for the mouth and nose secretions of healthy people often contain 
disease germs. Japanese napkins, tissue paper, or pieces of cloth which can 
be destroyed, are preferable on all accounts. 



CONSUMPTION 127 

Persons in health need have no fear whatever of 
the matter exhaled by the sick in ordinary breathing 
or in conversation. 

SPITTING 

The larger quantities of material, coughed up into 
the mouth, contain enormous possibilities of infection, 
but this source of danger is easily avoided by simply 
knowing where to spit. 

Many persons, women especially, swallow what 
they cough up. This is a bad habit. It is most 
unclean and disgusting to spit into your stomach, 
and if one has tuberculosis it is dangerous. Consump- 
tives would oftener get well if they were not repeat- 
edly reinfected, and to swallow the sputum is one 
way of renewing the infection. 

Those who have ordinary colds or pneumonia, 
or influenza, or tuberculosis, must spit, but they must 
not spit in such a way that they themselves or any 
other person can come in contact with any particle 
of the sputum. 

In the house no one, sick or well, should ever spit 
anywhere except into a vessel made for such purposes. 
Those who are out of health should have their own 
spittoons containing water or some disinfecting 
solution, or sputum cups of paper cheap enough to be 
dropped in the fire and destroyed, or a water-proof 
pocket or paper bag for cloths or absorbent paper 
napkins, which are burned as soon as they are soiled. 
A disinfecting solution in the spittoon is not absolutely 



128 HOME CARE OF THE SICK 

necessary, but it is absolutely necessary that the 
sputum should never be allowed to dry, and water in 
the spittoon will answer every purpose to accomplish 
this end. Spittoons should have perpendicular sides, 
and no slanting surfaces on which the sputum can 
stick and dry. It is well to place the spittoon on a 
piece of paper which will show if accidentally soiled, 
and can be easily destroyed. It is dried sputum, 
from which particles can rise as dust in the air, that 
is dangerous. 

For use on the street, or away from home, similar 
conveniences can be obtained, capable of being used 
quite decently and without attractmg attention. If 
one happens to be without such conveniences, when, 
it is absolutely necessary to spit, remember not to 
spit where anyone is liable to step on the sputum. 
It is a punishable offense to spit on the floor or plat- 
form of a trolley car or railway coach or on the floor 
of a railway station or public building, and in many 
places the law forbids spitting on a pavement. When 
you must spit, look about for a sewer opening or a 
gutter. 

When in company, and in a room, the tendency 
of the invalid is to swallow the sputum rather than at- 
tract attention,but this should not be done, as it is both 
dangerous to the patient and disgusting, and the ex- 
pectoration can always be received on pieces of cheese- 
cloth; or it would be better even, if necessary, to ex- 
pectorate in the handkerchief and burn it afterwards. 



CONSUMPTION 129 

Of the diseases considered in this circular the most 
important from every standpoint is tuberculosis. 
This disease, when it affects the lungs, is commonly 
called consumption. Nearly all diseases of the lungs 
are communicable in some degree, and the advice given 
in this circular can be followed with advantage by all 
persons who have 'cough or expectoration. 

TUBERCULOSIS OR CONSUMPTION 

Tuberculosis of the lungs, commonly called con- 
sumption, is the most common form of the disease. 
There is also tuberculosis of the throat, known as 
consumption of the throat ; tuberculosis of the bowels, 
called consumption of the bowels ; tuberculosis of the 
lymph glands, known as scrofula; tuberculosis of the 
various bones, as of the spine, which is the cause of 
hunch back; tuberculosis of the jomts, as of the hip, 
which is known as hip-joint disease; and various 
tuberculosis abscesses, known as white swelling. 

Tuberculosis is a communicable disease. 

Tuberculosis is a preventable disease. 

Tuberculosis is a curable disease. 

It is communicated from one person to another 
through the discharges from tuberculous ulcers, the 
principal source being the sputum which comes from 
ulcers in the lungs of persons suffering from consump- 
tion. 

It is a preventable disease, because if these dis- 
charges which contain bacilli were destroyed, there 
would be no spread of the disease. 



130 HOME CARE OF THE SICK 

That it is curable is proven by the fact that more 
than one-half of the people have tuberculosis some 
time in their life, and yet only about one in seven 
die of it. 

FIRST STEPS IN THE PREVENTION OF THE SPREAD OF CON- 
SUMPTION 

If the spread of consumption is to be prevented, the 
disease should be discovered as early as possible, and 
the patient should be told that he has the disease. 
He should at the same time be told that the disease 
is curable and that, in order to be cured and in order 
not to give it to others, he -must know that he has it. 
If the disease were discovered early and the patients 
thoroughly instructed and trained in being careful, 
there would be little danger of scattering infection. 

If you have a cough, don't say, "It's nothing but 
a cold." You may be injuring yourself and others. 
Go to a doctor who knows, and learn the truth. 

Persons suffermg from tuberculosis should earnestly 
desire to know that they have tuberculosis, that they 
mav take advantage of the modern methods of treat- 
ing the disease and be restored to health. They 
should know that "bronchial trouble," "throat 
trouble," "stomach cough," and such terms, are 
only deceptive and mean, in many cases, consump- 
tion They should also know that the spitting of 
blood, unless positively from, the gums, nose or throat, 
is in all probability from tuberculosis in the lung. 
Repeated protracted colds are often signs of tuber- 



CONSUMPTION 131 

culosis. A cough that hangs on for any length of 
time should always excite suspicion. 

DISPOSAL OF THE SPUTUM 

The expectoration of persons suffering from dis- 
eases of the lungs always contains ' infective germs, 
and the expectoration of consumptives is particularly 
harmful. The matter spat up by consumptives may 
soil the bedding, furniture, clothing, etc., and other 
persons handling these things may soil their hands 
and thus infect themselves. Consumptive persons 
are very likely to soil their hands through the pocket 
handkerchiefs which they use. It is best for persons 
suffering from any pulmonary disease not to use the 
ordinary pocket handkerchief at all. The Japanese 
paper napkins, tissue paper, or pieces of gauze, as 
as they are used but once, are less apt to soil the hands, 
and can be burned as soon as used. 

The best way of destroying sputum is to bum it. 
A number of disinfectants will destroy its infectious- 
ness, but their action is slow, uncertain, and they are 
more expensive than burning. Paper cups to receive 
the sputum are often furnished by State and Local 
Boards of Health, or they can be purchased at drug 
stores. These cups should be burned every day or 
every other day. In summer, when there is no fire 
in the house, a fire should be made with waste paper 
and wood for the purpose of burning the cups and 
paper napkins which have been used. The cups and 
napkins may be thrown into an earth closet and 



132 HOME CARE OF THE SICK • ' 

covered with dry earth or lime, as the germs soon die 
under these conditions. In hotels, flats and apart- 
ments, where there is no access to an earth closet or 
a fire, the patient should spit into a cup containing 
water or a disinfecting solution, and empty it every 
day into the water closet. In the earth closet and 
water closet the germs are not destroyed at once as 
by burning, but they cannot harm the patient or any 
one else, and they soon die. 

The sputum must not be thrown on the ground, 
or into a surface gutter, or thrown away with ashes, 
garbage, or other refuse. .The cover of the sputum 
cup should be kept closed to keep out flies and other 
insects, which may carry the sputum on their legs and 
bodies and distribute it wherever they afterwards 
alight. 

Sick persons who are walking about, away from 
home, where they cannot carry sputum cups, should 
spit into a Japanese paper napkin, tissue paper, or 
cheese-cloth, and put it at once into a waterproof 
pocket, or paper bags can be used for this purpose. 
The. waterproof pocket may be sewed or buttoned 
into the left pocket of the skirt or trousers. A supply 
of unused napkins should be carried in the right 
pocket. The paper napkins should be used only once. 
Sick patients, too weak to use the cups, should spit 
into Japanese napkins, bits of tissue paper, or pieces 
of gauze, which can be kept in a covered paste- 
board box or tin bucket, and afterwards burned. 



CONSUMPTION 133 

It is well always to wipe the lips after expectorating. 

If the sputum accidentally gets on the floor, cloth- 
ing, or furniture, a thorough washing with laundry 
soap and water should immediately be applied. 

Persons whose sputum contains disease germs, 
especially those of tuberculosis, should frequently 
wash their hands with soap and water. Patients 
who cook or prepare food should take especial care 
to have clean hands. 

The beard and moustache are sure to be infected, 
and probably help the consumptive to reinfect him- 
self by contaminating his food and drink. The beard 
should be removed or trimmed quite short. 

SPECIAL DIRECTIONS FOR MEMBERS OF THE HOUSEHOLD 

Young children should not be allowed to play in the 
sick-room of anyone who has any disease of the lungs. 
Playing on the floor of the sick-room especially should 
be absolutely forbidden. 

The germs of consumption are more dangerous for 
children than adults. 

Mothers with tuberculosis should not nurse their 
infants, as nursing involves a considerable danger 
to the child and a heavy drain upon the mother's 
vitality. Mothers should thoroughly wash their 
hands before preparing the bottles or handling the 
infants' food. 

Patients with pulmonary disease should not kiss 
anyone on the mouth. If the mouth and lips have 



134 HOME CARE OF THE SICK 

been carefully cleansed, kissing perhaps is but slightly 
dangerous. 

Towels, pipes, clothing, handkerchiefs and other 
personal articles used by a tuberculosis person should 
not be used by other members of the family. When 
consumptives are bedridden their clothing and bed- 
ding ought not to be thrown into the common recep- 
tacle for soiled clothes. Such things as can be boiled 
should be boiled as soon as possible, or else soaked 
for several hours in a disinfecting solution. 

CARE OF THE SICK-ROOM 

A person suffering from consumption should occupy, 
if possible, a sunny room, and one that can be well 
ventilated. If the room is not so arranged that there 
can be good ventilation, so as to frequently change 
the air, the patient should draw his bed near the 
window, so as to get as much fresh air as possible. 

If the floors and walls of the room have become 
soiled by sputum the room should be disinfected by 
formaldehyde gas. If possible, the room should be 
disinfected, and afterwards the walls scraped, and 
repapered, repainted, or rekalsomined. After that 
the walls should not become infected again in many 
months, provided the coughing and spitting are 
properly cared for. 

The floors may be washed with hot soda lye. The 
floor should be bare or covered with wash cotton rugs. 

Heavy curtains should be removed, and sash 



• . CONSUMPTION ■ 135 

curtains of washable materials substituted. Roller 
shades are not objectionable, unless they exclude too 
much daylight. 

Do not sweep or dust the room. The floor should 
be wiped at least once a week with a damp cloth. 
The bed, furniture, woodwork, mantels, etc., should 
be wiped off in the same manner. 

The patient should have his own bed, and if possible 
his own room. It is injurious to the invalid and 
dangerous to the well person to occupy the same bed. 

The bedroom should not be used as a dining- 
room or kitchen if it is possible to avoid it. 

The windows should be kept open. 

The cardinal principles to be observed in the sick- 
room are cleanliness, sunlight, fresh air, and care of the 
sputum. 

THE CURE OF DISEASES OF THE LUNGS 

Consumption is not a very fatal disease. The 
majority of those attacked recover. More than in 
any other disease the outcome of a case of tuber- 
culosis is in the hands of the patient. The develop- 
ment of consumption is caused by errors in our ways 
of living; some of these are nature's errors, some 
errors of circumstance, and some our own personal 
errors. Medical experience has shown that we can 
easily overcome the adverse chances of nature and 
circumstance if we correct our personal errors of 
hygiene. 



136 HOME CARE OF THE SICK 

HOW TO MAKE HEALTHY LUNGS DISEASED 

1. Exposure to dust containing germs. 

2. Drinking excessive amounts of alcoholic liquor. 

3. Loss of sleep, worry and. confinement. 

4. All forms of dissipation and excess. 

5. Unwholesome and improperly cooked food. 

6. Meals at irregular hours. 

7 Working or living in a dusty or vitiated atmos- 

phere. 

8 Prolonged hours of work. Severe and pro- 

longed muscular or mental exertion. Work 
requiring a constrained or stooping posture. 
9. Exposure to extreme heat, noxious fumes, 
injurious dust, dampness. 

10. Certain occupations: Stone-cutting, file-grind- 

ing, and dusty occupations generally. 

11. Contracting diseases which aggravate or predis- 

pose to consumption — measles, Vv/'hooping- 
cough, grippe, and pneumonia. 

12. Exposure in the room of a careless consumptive. 

13. Drinking of milk of tuberculous cows, especially 

by children. 

HOW TO MAKE DISEASED LUNGS HEALTHY 

I. The person suffering from tuberculosis should be 
careful to destroy his sputum. He should not 
soil his hands, handkerchief, clothes, bed 
clothes, or anything about him with his expec- 
toration. In case any of these should become 
soiled, they should be cleaned and disinfected 



CONSUMPTION 137 

at once. He should not swallow his expecto- 
ration; he should not associate with other 
persons who have the disease and are careless 
about their expectoration, for by carelessnes 
on his own part or that of others he may be 
reinfected. 

2. Employ an intelligent physician. Consult him 

about food, drink, work, rest, amusements, 
exercise, and all the details of daily life, in- 
cluding the expediency of going to a sanato- 
rium, or adopting sanatorium regime in your 
own home. 

3. Don't spend one cent for advertised cures, for 

they never cure. 

4. Take the four cures: 

The air cure ; 
The food cure; 
The rest cure ; 
The mind cure. 

5. Sleep well, don't worry, keep out of doors. Be 

confident that you are going to get well. 

6. Don't take any liquor, except on a physician's 

prescription. 

7. Eat plenty of meat, milk, butter and eggs — all 

you want, and want as much as you can eat. 

8. Avoid the frying pan and its products. 

9. Keep regular hours, good company and a clear 

conscience. 



138 HOME CARE OF THE SICK 

10. Your most inportant duty is to get well; let all 

other duties be secondary. 

11. If your work involves long hours, prolonged and 

severe mental or muscular exertion, stooping 
position, inhalation of dust or noxious fumes, 
leave it if you want to get well. 

HOW TO KEEP HEALTHY LUNGS HEALTHY 

1. Keep your general health in as good condition 

as possible by avoiding excess, and by living 
as hygienically as possible. 

2. Follow the ^foregoing rules as faithfully as your 
occupation permits. 

Numerous investigations have shown that pro- 
longed and repeated exposures are necessary to cause 
tuberculosis in a healthy person ; accordingly there is 
little danger to be feared from casual exposure to 
consumptives. 

Any one may safely live in the same apartments 
with a consumptive, provided the simple precautions 
given in this Circular of Information are observed. 

Tuberculosis is not a contagious disease like 
measles or small-pox. It is, however, a communi- 
cable disease, and we know just where the danger lies 
and how easy it is to avoid it. It is not the consump- 
tive himself, but the consumptive's expectoration 
which is dangerous to those about him. If the simple 
directions given above are followed by him, the con- 
consumptive ceases to be a source of danger to those 
about him. 



CONSUMPTION 139 

AS TO CHANGE OF CLIMATE 

Climate in Consumption is a will-o'-the-wisp. It 
is the end of the rainbow with its pot of gold. It is 
ever just a little beyond. It rests in Colorado, New 
Mexico, Arizona, California. Like children in their 
simple faith, chasing the rainbow's vanishing end and 
delving for treasures where once it stood, our patient 
pursues his phantom till, worn and wasted, weary, but 
hopeful still, he falls asleep and wakes to learn that 
the magic end of the bow of promise rests upon the 
mystic shores of the spirit land. 

"While certain climates may be preferred for cer- 
tain consumptives, it is nevertheless the consensus 
of opinion of the leading authorities of the day that 
there is no climate which has a specific curative 
power over consumption. Many, including Dr. S. A. 
Knopf, of New York, an acknowledged expert on the 
treatment of Consumption, hold that cures effected 
in the home climate in which the patients will have 
to live and work after their restoration to health, are 
more lasting and assured than cures obtained in more 
genial climes. While it is known that patients cured 
in the salubrious regions of the West have been able 
to return and live in Illinois and eastern states from 
whence they came, it is also known that others can 
never leave the climates in which they recovered, for 
on their return to their own state their disease recurs. 

"There are many reasons why an attempt should be 
made to cure a consumptive patient at or near his 



140 HOME CARE OF THE SICK 

own home, if it be in a climate not unsuitable for the 
cure of Consumption; many reasons why he should 
not be sent -a long distance from home. 

Separation from friends depresses the patient. 
"Homesickness" is a malady which often baffles the 
physician. 

The expense of the journey is a serious drain on his 
resources and is often incurred unnecessarily. As 
has been aptly stated by the State Board of Health 
of Maine, "many patients could be well put on the 
road to recovery in their own state at a cost which 
would barely defray their expenses to and from Colo- 
rado and Arizona." 

The fatigue of a long journey is bad for a consump- 
tive. 

The lack of home comforts in a distant state and 
the inability often to obtain proper accommodations 
unless at a prohibitive price naturally handicap the 
best efforts made to cure the patient. 

The expense of living in the states having "specific" 
climates is great. Even if his disease be cured, the 
patient may not be able to return to live in his home 
state. 

If the patient must work, he can find no occupa- 
tion. Too many have preceded him. 

. It is known that in certain Western states doors 
are closed to the consumptive, and legislation against 
him is contemplated. 

For the wealthy patient, who can be surrounded 



CONSUMPTION 141 

by his relatives and friends wherever he goes, a change 
of cHmate may be desirable; for the poor patient — 
and Consumption is often a disease of the -poor — a 
change of climate frequently quickens an unfavor- 
able termination of his disease. 

The consumptives of Illinois should not forget that 
their disease can, as a rule, be cured in Illinois, if it 
can be cured anywhere. — Bulletin on Consumption, 
Illinois State Board of Health 



THE GREAT WHITE PLAGUE 

" It is with a very real sense of melancholy that one 
contemplates the long death-roll of those of the 
world's great men and women who have succumbed 
untimely to the tubercle-bacillus, which is and has 
been through countless generations by far the most 
potent of all death-dealing agencies. Had it not been 
for this detestable parasite, Bastien Le Page might 
have given us another Joan-of-Arc to feast our eyes 
upon ; Rachel might for many years have continued 
to permeate the spirits of her audiences with the di- 
vine fire that was in her. Our navy did well enough 
in the 18 12 war, as all the world knows; but what a 
rip-roaring time there would have been if John Paul 
Jones had lived to take a hand in it! We might 
be reading some more of Stephen Crane's splendid 
war stories ; we might have had some more of Robert 
Louis Stevenson 's delicious lace-work ; Schiller might 
have given us another Song of the Bells; we might 



142 HOME CARE OF THE SICK 

have taken another 'Sentimental Journey' with 
Laurence Sterne; Henry Cuyler Bunner might have 
continued to delight us, and to touch our hearts ; John 
Keats might have given us another 'Endymion.' Had 
the tubercle-bacillus permitted, Nevin might have 
vouchsafed us another 'Rosary'; von Weber another 
'Euryanthe Overture'; Chopin might have dreamed 
another 'First Polonaise' ; and the tender flute notes 
of Sidney Lanier might even now be heard. Maria 
Constantino vna BashkirtsefE, Zavier Bichat, John 
Godman, Rene Theophile Hyacinth Laennac, Henry 
Purcell, John Sterling, Henry Timrod, Artemus Ward, 
Henry Kirke White, Henry David Thoreau, Baruch 
Spinoza — such names as these are but a moiety among 
those of the world's nobility whose precious lives 
were cut off in their prime by the 'Great White 
Plague.' " — From Popular Science Monthly, by Dr. 
John B. Huber. 



Of the people living in the United States to-day over 
8,000,000 will die of tuberculosis, at the present death rate. 
All these lives might be saved. 



CONSUMPTION 143 

DEATHS IN NEW HAMPSHIRE. 1884-1904 

COMPARISON or WELL-KNOWN CAUSES 

{^■^■■{■■■^■■■■i CONSUMPTION 

■■■ DIPHTHERIA AND CROUP 

■■I TYPHOID FEVER 

■ SCARLET FEVER 

I MEASLES 

I SMALLPOX 

DIAGRAM OF PREVENTABLE DISEASES. 




During this period there died in 
New Hampshire, from all causes, 
between the ages of 20 and 80, 
lO,028 persons, of whom 8,981 
succumbed to consumption ; or, in 
other words, 89.69 per cent., or 
one to two and a fraction deaths 
were caused by consumption. 



DIAGRAM SHOWING PROPORTION OF DEATHS 
FROM CONSUMPTION TO DEATH FROM ALL OTHER 
CAUSES BETWEEN THE AGES OF TWENTY AND 
THIRTY YEARS. BLACK, CONSUMPTION; WHITE, 
ALL OTHER CAUSES. 



144 



HOME CARE OF THE SICK 




DEATH RATE FROM CONSUMPTION IN NEW 
HAMPSHIRE BY AGES. 




MORTALITY FROM CONSUMPTION TO EACH 10,000 
OF THE SAME AGE, IN NEW HAMPSHIRE, FOR 20 
YEARS. 



PNEUMONIA* 

Definition. — Pneumonia is an infectious inflamma- 
tion of the lungs, due to a specific micro-organism, 
the micrococcus pneumonicc, which produces a potent 
poison, affecting the whole system and frequently 
causing death. 

The Virulence of the Germ. — The virulence of the 
germ of pneumonia is subject to wide variations. In 
the bacteriological laboratory there are cultures one- 
millionth of a cubic centimeter of which will induce 
death in animals, while there are other cultures twen- 
ty times the above given amount of which are neces- 
sary to produce the same effect. As a rule, the viru- 
lence is increased when the germ passes directly from 
one person or one animal to another. This is one of 
the reasons why the disinfection of the sputum of the 
person suffering from pneumonia is so desirable. 

Importance of Pneumonia as a Cause of Deaths 

Averaging the mortality statistics of Michigan, col- 
lected under the new law, for the six years, 189 8- 1903, 
the latest yet compiled by the State Department, the 
order of importance of the most dangerous communi- 
cable diseases, as causes of deaths, was as follows: 
Pneumonia, tuberculosis, meningitis, typhoid fever, 
diphtheria, whooping-cough, scarlet fever, measles, 
and small-pox. The relative importance of these 
diseases, in those years, is shown by the diagram. 

♦Leaflet of the Michigan State Board of Health. 



146 HOME CARE OF THE SICK 

DEATHS IN MICHIGAN 6 YEARS. r898-l903. 



■■i PNEUMONIA 
TUBERCULOSIS 




MENINGITIS 
TYPHOID FEVER 
DIPHTHERIA 

■■ WHOOPING-COUGH 

■i SCARLET FEVER 

■i MEASLES 

(SMALLPOX . 

During the ten years ending with 1897, the statis- 
tics collected under the old law showed that then the 
most dangerous communicable diseases, named in the 
order of their importance, were: Tuberculosis, pneu- 
monia, diphtheria, typhoid fever, influenza, scarlet 
fever, meningitis, measles, whooping-cough and small- 
pox. It will be seen that pneumonia was then ex- 
ceeded only by tuberculosis as a terrible death-dealing 
scourge. Tuberculosis has continued to decrease. 
Pneumonia has been rapidly replacing tuberculosis 
and is now the greatest single cause of deaths in 
Michigan 

The Mode of Communication. — It is by means of 
sputa (all discharges from the lungs, throat, nose, and 
mouth) containing micro-organisms capable of pro- 
ducing pneumonia that this dangerous disease is 
usually spread. 

Destruction of the Sputa., — It is evident that the 
most certain preventive of pneumonia is to destroy 



PNEUMONIA 147 

the sputum from the patient before it has an oppor- 
tunity to dry and scatter the germs of disease. 

How the Sputa Should be Destroyed. — During the 
illness great care should be taken to prevent soiling 
bed clothing, carpets, or furniture with the sputa. 
The patient should cough into a moistened cloth and 
the cloth should be burned before allowmg it to 
become dry. It is not a sufficient precaution to exer- 
cise this care during the patient's brief illness, 
because the germs causing pneumonia are capable of 
living for a considerable time in the mouth and nose 
of a person who has had the disease. Therefore, dur- 
ing convalescence, so long as any sputum is raised 
from the lungs, and for at least two or three weeks, all 
expectoration should be into a cup or cuspidor con- 
taining a disinfectant, the best disinfectant being a 
five per cent solution of carbolic acid — one ounce of 
carbolic acid dissolved in a pint and a half of water. 
If not confined to the house, it is best that the conva- 
lescent, and that all persons who have a cough, should 
carry small pieces of cloth (each just large enough to 
properly receive one sputum) and paraffined paper 
envelopes or wrappers in which the cloth, as soon as 
once used, may be put and securely enclosed, and, 
with its envelope, burned on the first opportunity. 
Remember that the sputum must not be allowed to 
become dry. 

The Spitting Nuisance Dangerous to the Public 
Health. — It is now well known that the human saliva 



148 HOME CARE OF THE SICK 

is the natural habitat of many species of micro-organ- 
isms which gain access to the mouth in various ways, 
the most common being by breathing, through the 
mouth, air containing them. In a case of pneumonia, 
however, the germs of the disease are coughed up 
from the lungs. The sputum is, therefore, the com- 
mon way by which pneumonia and some other dan- 
gerous communicable diseases are spread. After dry- 
ing, the germs with which the sputum is charged 
mingle with the dust of rooms in homes, churches, 
schools, public halls, stores, and cars, In these places 
they are inhaled by human beings, with results depen- 
dent largely upon physical and meteorological condi- 
tions. The physical and meteorological conditions 
cannot always be avoided; therefore, success in the 
restriction of those diseases must lie in the direction 
of the destruction of the germs which produce those 
diseases. It is probable that, could the sputum al- 
ways be destroyed as soon as ejected, pneumonia and 
a few other important diseases would soon disappear. 
We are confronted with the practical problem of how 
this may be done, either wholly or in a large degree. 
This problem is not an easy one to solve, for the reason 
that every man regards himself as independent and 
endowed with the inalienable right enjoyed by man 
throughout all ages, of depositing saliva wherever he 
chooses. Many municipalities are indeavoring to 
enforce regulations more or less stringent to prohibit 
spitting upon sidewalks and in other public places. 



PNEUMONIA 149 

These efforts are largely due to the knowledge now 
becoming so common that the germs of tuberculosis 
are spread by the air containing the germs of this dis- 
ease which have been ejected in the sputum of the 
victims of the disease. When it becomes generally 
understood that sputum may contain not only germs 
of tuberculosis, but also the germs of pneumonia and 
of other dangerous communicable diseases, the efforts 
that are now being put forth to prohibit this public 
and dangerous nuisance should be largely increased. 
Legal measures can be used only against the per- 
son spitting in public places. The person who con- 
taminates the air of his home with his saliva is largely 
beyond the reach of such measures. Public opinion 
is necessary to sustain the enforcement of any law. 
It is especially necsssary where it is sought to enforce 
a law depriving citizens of a privilege they have long 
enjoyed and can see no reason why they should not 
continue to possess. Education of the people con- 
cerning the importance of destroying or disinfecting 
all sputum must, therefore, precede forcible measures. 
This education should be such as to induce every in- 
telligent person to destroy or disinfect the sputum or 
saliva he or she ejects, and to insist that the careless 
and the ignorant be compelled to do likewise. It is 
to be hoped that such education will result in the 
formation of public opinion, so that it will demand that 
the law shall not only reach the public spitter, but 
that it will also apply to the person who contaminates 



ISO HOME CARE OF THE SICK 

his own home, thus not only endangering his own 
family, but also endangering the lives of all who may 
enter such a home. The press, the teachers in our 
public shcools, the preachers in our pulpits, and all 
others who in any degree mould public opinion should 
urge this most important sanitary reform. 

Isolation of the Patient.— It is believed that if care 
is taken with all the discharges from the nose and 
mouth, isolation of the patient may not always be 
necessary, although it is undoubtedly wise for all who 
can do so, and especially all children, to keep away 
from the patient. And, pneumonia being an acute 
disease, of short duration, isolation may properly be 
practiced. 

Ventilation of Buildings. — Through better systems 
of ventilation, much may be done for lessening the 
number of micro-organisms inhaled with the dust of 
floors, carpets, etc., especially by having the foul air 
exits at the floor level, so that the general motion of 
the foul air shall be downwards, and not upwards into 
the nostrils of the inmates of the room. This is 
especially important with reference to all public build- 
ings, as, also, that they shall constantly have a liberal 
supply of fresh air. 

Personal Precaution. — Any person dusting ob- 
jects in a room, cleansing the floors, walls or ceiling 
of the living or sleeping room of a person suffering 
with pneumonia might well use a respirator. Sev- 
eral folds of gauze moistened and tied loosely over the 



PNEUMONIA 151 

nose and mouth might be used. The sweeping and 
dusting of a room which has recently been occupied 
by a person sick with pneumonia should be deferred 
until after the room and contents have been subjected 
to the fumes of burning sulphur, or of formaldehyde. 

No one should sleep in the same room with a pa- 
tient, nor in a room which has been recently occupied 
by a person sick with pneumonia, unless the room 
(with all its contents) has been previously thoroughly 
disinfected. 

It is best not to stand near a person who is cough- 
ing, because in coughing finely divided droplets of 
saliva are thrown from the mouth and may be carried 
for a distance of three feet. These droplets may con- 
tain large numbers of germs. They are also sometimes 
thrown out in forcible speaking. The ordinary breath 
does not contain them. 

Much may be done to lessen the liability to con- 
tract pneumonia, by having the sanitary surround- 
ings as nearly perfect as possible, and by keepmg the 
lungs strong and healthy. These facts emphasize the 
importance of pure food, pure air, and healthful exer- 
cise. 

Exposure to Cold Wind should be Avoided. — Statis- 
tics of sickness and of deaths, collated with meteoro- 
logical statistics, prove that the colder months of the 
year and those following are the months during which 
pneumonia prevails most extensively, and during 
which it sometimes assumes an epidemic form. At 



152 HOME CARE OF THE SICK 

such times every person should avoid exposure to cold 
wind and to chill from a change from heavy to light 
clothing. 

Disinfection. — Disinfection of rooms and contents 
can be complete only in the absence of living persons, 
as fumes strong enough for the purpose are destruc- 
tive of human life. Curtains, draperies, carpets, 
clothing and all movable articles should he exposed to 
sunlight in the open air. The unwashed clothing of 
a person sick with pneumonia should not be mingled 
with the unwashed clothing of another person; care 
should be taken that the handkerchiefs be boiled, and 
other articles likely to harbor the germs be disinfected 
before sending them to the laundry. 

After a death or recovery from pneumonia, the room 
in which there has been a case of this disease, and the 
furniture and other contents, should be thoroughly 
exposed for several hours to formaldehyde gas, or to 
fumes of burning sulphur, and then exposed for 
several hours to currents of fresh air. Hang up and 
spread out as much as possible all blankets and other 
articles to be disinfected ; turn pockets inside out, and 
otherwise facilitate the access of the disinfecting 
fumes to all infected places. For a room ten feet 
square, at least eight ounces of a forty per cent solu- 
tion of formaldehyde, or at least two ounces of solidi- 
fied formaldehyde should be rapidly distilled into the 
room, or at least three pounds of sulphur should be 
rapidly burned ; and for larger rooms proportionately 



DIPHTHERIA 153 

increased quantities should be used, at the rate of at 
least eight ounces of a forty per cent solution of for- 
maldehyde, or at least two ounces of solidified formalde- 
hyde, or three pounds of sulphur per each one thous- 
and cubic feet of air-space. After fumigation, the 
walls may be whitewashed, albastined, painted, 
repapered, or rubbed with bread-crumbs, which should 
then be burned ; the woodwork, including the floor, 
may be painted or thoroughly washed. If any sputum 
is deposited thereon, it should be washed with a five 
per cent solution of carbolic acid . 



DIPHTHERIA* 



Diphtheria is a dangerous communicable disease, 
caused by a specific contagium, the germ of which 
is propagated in the human body or its excretions, 
and spread from person to person, directly and indirect- 
ly. Until recent years, the supposition has prevailed 
that cases of diphtheria might arise de novo from a 
filthy condition of premises, backyards, privy vaults, 
cesspools, etc. ; but later researches have made it 
plain that this notion is not a correct one. Filthy 
conditions may serve to harbor the germs, but they do 
not produce the germ. Rather, it seems to have been 
proved from statistics compiled in this department 
that at least four-fifths of the cases of diphtheria in 
Michigan come almost directly from a preceding case. 

The hacilhis which causes diphtheria does not gen- 

*Bulletin of the Michigan State Board of Health. 



154 HOME CARE OF THE SICK 

erally enter the blood. The poison generated by the 
bacillus is absorbed into the body, and causes degen- 
erations of muscular tissue, heart failure, paralysis, 
etc. ; but the germ generally remains in its locality, 
usually in the throat. Therefore the spread of this 
disease is mainly from the throat and mouth. Every- 
thing touched by the mouth, or by the discharges 
from the mouth, throat or nose, may be infected. 

HOW TO AVOID AND PREVENT DIPTHERIA 

Avoid the Special Contagium of the Disease. — This 
is especially important to be observed by children. 
Children under ten years of age are in much greater 
danger of death from diphtheria than are adults ; but 
adult persons often get and spread the disease, and 
sometimes die from it. Mild cases in adults may 
cause fatal cases among children. Because of these 
facts it is frequently dangerous for children to go 
where adult persons go with almost perfect safety to 
themselves. 

Do Not Let a Child Go Near a Case of Diphtheria. — 
Do not permit any person or thing, or a dog, cat, or 
other animal to come from a case of diphtheria to a 
child. No cat or dog should be permitted to enter 
the sick-room. Unless your services are needed, keep 
away from the disease yourself. If you do visit a case, 
bathe yourself and change and disinfect your clothing, 
hair, beard, if any, and hands, before you go where 
there is a child. 



DIPHTHERIA 155 

The contagium of diphtheria sometimes retains its 
virulence for a long time, and may be carried a long 
distance in articles in which it has found lodgment. 
Do not permit a child to enter a privy or water closet, 
or to breathe the air from a privy, water closet, cess- 
pool or sewer into which undisinfected discharges 
from persons sick with diphtheria have entered, nor 
to drink water or milk which has been exposed to 
such air. 

Do not permit a child to ride in any closed carriage 
in which has been a person sick with diphtheria, 
except the carriage has since been thoroughly disin- 
fected with fumes of burning sulphur. 

Abrasions of the skin or mucous membrane favor 
the contraction of diphtheria. The disease spreads 
most at such seasons of the year as sore throats prevail. 
All influences which cause sore throats, such as expo- 
sure to wind and to breathing cold, dry air, probably 
tend to promote the taking and spreading of this 
disease. 

Do not permit a child to wear or handle clothing 
worn by a person during sickness or convalescence 
from diphtheria. 

Beware of any person who has a sore throat. Do 
not kiss or come near to such a person. Do not drink 
from the same cup, blow the same whistle, or put his 
pencil or pen in your mouth. 

Beware of crowded assemblies in unventilated 
rooms. 



1.56 HOME CARE OF THE SICK 

Individual drinking cups should be used. A com- 
mon drinking cup should not be used, especially in 
school-rooms and places where there is liability of in- 
fection. Diphtheria bacilli have been found on cups 
in actual common use in schools. A fountain cup 
would be less liable to spread disease, because the 
water continually overflows the sides and tends to 
wash away any infection which might otherwise col- 
lect on the edges of the cup. 

Children believed to be uninfected may be sent 
away from the house in which there is diphtheria, to 
families in which there are no persons liable to the 
disease, or to previously disinfected convalescent 
wards in hospitals ; but in either case they should be 
isolated from the public until the expiration of the 
period of incubation, that is, the iiiterval of time be- 
tween exposure to the contagium of diphtheria and 
the first sign of the disease in the person so exposed. 
This time may vary. In many cases it may appear 
in seven days, in some cases twelve days or more ; the 
average period is about seven or eight days, but for 
full protection to the public isolation should be 
observed for two weeks, at least. 

Exposed persons should be isolated until this time 
has elapsed. 

The administration of antitoxic serum, by physi- 
cians, has been found to be safe and quite effective 
as a preventive measure, especially in children; and 
when circumstances are such that they must remain 



DIPHTHERIA 157 

in the same house with a person sick with diphtheria, 
the antoxin is so very important that it cannot prop- 
erly be neglected. But even where the antitoxin is 
administered, isolation of a person exposed to diph- 
theria is advised, to prevent the spread of the disease. 

Where Diphtheria Is Present in a Community. — 
When a child or a young person has a sore throat, 
bad odor to its breath, especially if it has fever, it 
should immediately be kept separated from all other 
persons, except necessary attendants, until it be 
ascertained whether or not it has diphtheria or some 
other communicable disease. 

Persons who are attending upon children or other 
persons suffering from diphtheria, and also the mem- 
bers of the patient's family, should not mingle with 
other people nor permit the entrance of children into 
their house. 

SANITARY CARE OF INFECTED AND SICK PERSONS AND 
ROOMS 

Membranous Croup. — Modem researches point to a 
probable common origin of diphtheria and membran- 
ous or inflammatory croup, differing only in location 
from true diphtheria; therefore, membranous or in- 
flammatory croup should be recognized as a commu- 
nicable disease dangerous to the public health, and 
should be reported, and isolation and disinfection 
should be enforced the same as in other cases of 
diphtheria. 

In all cases of sore throat, precaution should be 



158 HOME CARE OF THE SICK 

taken. It is often difficult to distinguish mild cases 
of diphtheria from a simple tonsillitis, pharyngitis, or 
laryngitis, and such mild cases of diphtheria often 
communicate a dangerous and fatal form of diphtheria ; 
therefore, it is the duty of physicians and householders 
in reporting diseases dangerous to the public health, 
and of local health authorities in their efforts to restrict 
such diseases, in every case, to give to the public 
safety the benefit of the doubt, and in localities where 
diphtheria exists to regard cases of acute sore throat 
as suspected cases of diphtheria. 

Bacteriological Tests. — No health officer should fail 
to act for the restriction "of diphtheria in any case of 
sore throat in which there is doubt, certainly not until 
bacteriological tests have indicated the absence of 
Loffier bacillus (now known to be the specific cause of 
true diptheria). Such tests will be made at cost by 
the "State Laboratory of Hygiene, Ann Arbor, Michi- 
gan." Disease germs cannot lawfully be sent by 
mail, except in special mailing cases. 

Every person known to be sick with diphtheria 
should be promptly and thoroughly isolated from the 
public. 

In ordering the isolation of infected or exposed per- 
sons, the health officer means that their communica- 
tion with well persons, and the removal of any article 
from the infected room or premises, shall be abso- 
lutely cut off, unless such communication is carried 
on only under his supervision. Except it be disin- 



DIPHTHERIA 159 

fected, no letter or paper should be sent through the 
mail from an infected place. 

That this is of more importance than in the case of 
small-pox is indicated by the fact of the much greater 
number of cases of sickness and of deaths from 
diphtheria. 

The room in which one sick with this disease is to 
be placed should previously be cleared of all needless 
clothing, drapery, and other materials likely to harbor 
the germs of the disease; and, except after thorough 
disinfection, nothing already exposed to the conta- 
gium of the disease should be moved from the room. 
The sick-room should have only such articles as are 
indispensable to the well-being of the patient, and 
should have no carpet, or only pieces which can after- 
wards be destroyed. Provision should be made for 
the introduction of a liberal supply of fresh air and 
the continual change of the air in the room without 
sensible currents or drafts. 

Handkerchiefs, that need to be saved, should not be 
used by the patient ; small pieces of rag should be sub- 
stituted therefor, and after being once used should be 
immediately burned. 

Soiled clothing, towels, bed-linen, etc., on removal 
from the patient, should not be carried about while 
dry, but should be placed in a pail or tub and covered 
with a two per cent solution of carbolic acid Soiled 
clothing should, in all cases, be disinfected before 
sending away to a laundry, either by boiling for at 



i6o HOME CARE OF THE SICK 

least half an hour, or by soaking in a two per cent 
solution of carbolic acid. 

The discharges from the throat, mouth, and from 
the kidneys and bowels of the patient should be 
received into vessels containing an equal volume of a 
five per cent solution of carbolic acid, and in cities 
where sewers are used, thrown into the water closet; 
elsewhere the same should be buried at least loo feet 
distant from any well, and should not by any means 
be thrown into a running stream, nor into a cesspool 
or privy, except after having been thoroughly disin- 
fected. Discharges from the nose, bladder, and bowels 
may be received on old cloths, which should be imme- 
diately burned. All vessels should be kept scrupu- 
lously clean and disinfected. 

All cups, glasses, spoons, etc., used in the sick-room 
should at once on removal from the room be washed 
in the disinfecting solution mentioned above, and 
afterwards in hot water, before being used by any 
other person. 

Food and drink that have been in a sick-room, 
or otherwise infected with diptheria, should be 
destroyed or burned. They should not be put in the 
swill barrel. 

Perfect cleanliness of nurses and attendants should 
be enjoined and secured. As the hands of nurses of 
necessity become frequently contaminated by the 
contagium of the disease, a good supply of towels and 
basins, — one containing a two per cent solution of car* 



DIPHTHERIA i6i 

bolic acid, and another for plain soap and water, — 
should always be at hand and freely used. 

All persons recovering, or very recently recovered, 
from diphtheria should be considered dangerous ; there- 
fore, such a person should not be permitted to asso- 
ciate with others, or to attend school, church, or any 
public assembly until the throat and any sores which 
may have been on the lips or nose are healed, nor until, 
in the judgment of a careful and intelligent health 
officer, he can do so without endangering others. The 
bacillus which is the specific cause of diphtheria has 
been found in the throat weeks after apparent com- 
plete recovery from the disease. 

In a house infected with diphtheria, a temporary dis- 
infection after apparent recovery may be made, so 
as to release from isolation the members of the house- 
hold who have not had the disease, but those released 
should be kept under surveillance by the health officer 
for seven or eight days. After the period of infec- 
tiousness has passed, a final disinfection of the room 
occupied by the convalescent should be made. 

Disinfection is Necessary — Diphtheria bacilli in a 
comparatively dry state remain capable of renewed 
activity for at least four or five months. Therefore 
dust derived from the discharges from the throat, 
mouth, or nose may cause the disease months after 
the bacilli have left the throat in which they were 
propagated. This is the reason why disinfection is 
necessary. 



i62 HOME CARE OF THE SICK 

FINAL PRECAUTIONS 

After a death or recovery from diphtheria, the law 
requires that thorough disinfection of the infected 
person and premises be made before releasing the per- 
son from isolation, and that the local board provide 
for a temporary shelter during disinfection. Disin- 
fection of a room always necessitates vacating it, and 
sometimes makes it impossible to remain in adjoin- 
ing rooms; therefore, in some cases it seems essential 
to have hospital, tent, or temporary shelter for the 
inmates of infected houses, where bathing, disinfection 
and washing can be done while such houses are being 
disinfected and put in order. 

Disinfection of the person, after recovery, consists 
of a thorough washing with soap and water of the per- 
son, hair, and beard, if any. Under the direction of 
a physician an antiseptic bath m.ay be employed ; but 
antiseptics 'are, as a rule, poisons to be carefully used 
as directed by a physician. A common antiseptic is 
bichloride of mercury (corrosive sublimate) , one part 
to one thousand parts of water. 

All infected articles, including the clothing worn by 
the patient during recovery, should immediately be 
destroyed or disinfected in a way so careful and com- 
plete that the contagium have no opportunity to 
spread the disease in the process. Articles of small 
value, or which cannot be properly disinfected, should 
be burned by a quick, strong fire. 

Thorough disinfection should be made of the sick- 



DIPHTHERIA 163 

room, its contents, and all articles handled by the 
convalescing patient. Germs have been known to 
remain for a long time in the clothing, especially if 
woolen, and packed away in drawers or trunks; and 
books and furs that have been used or handled by 
those convalescing from this disease are particularly 
liable to convey the poison to children who have never 
had the disease. Therefore, great care should be 
taken to spread out as much as possible all clothing, 
turning the pockets inside out; to expose as great a 
surface as possible of the bedding to the disinfectant. 
Cotton, linen, flannels, blankets, etc., should be treat- 
ed with the boiling-hot water, introducing them piece 
by piece, securing thorough wetting and boiling for at 
least half an hour. Heavy woolen clothing, silks, furs, 
stuffed bed covers, beds and other articles which can- 
not be boiled, should be hung in the room during fumi^ 
gation, pockets being turned inside out and the whole 
garment being thoroughly exposed. Afterward, they 
should be hung in the open air, beaten and shaken. 
Carpets are best fumigated on the floor, but should 
afterward be removed to the open air and thoroughly 
beaten. Pillows, beds, stuffed mattresses, uphol- 
stered furniture, etc., after being disinfected on the 
outside, may be cut open and their contents again 
exposed to fumes of burning sulphur. In no cases 
should the thorough disinfection of clothing, bedding, 
etc., be omitted. Infected clothing and bedding have 
been known to communicate diphtheria months after 



i64 HOME CARE OF THE SICK 

their infection. As diphtheria germs have been known 
to find lodgment in wall-paper and remain active for 
months, all paper should be removed from the walls 
of a room occupied by a diphtheria case, before disin- 
fecting said room. After disinfection the woodwork 
should be washed with a i-iooo solution of corrosive 
sublimate, or a two per cent solution of carbolic acid; 
or better still, painted over with a coat of paint. 

Rooms should be disinfected either with sulphur or 
formaldehyde. For each thousand cubic feet of air 
space to be disinfected, three pounds of sulphur should 
be burned. Thus for a room about ten feet square, 
three pounds of sulphur should be used. The best 
results are obtained by using roll brimstone broken 
up, or flowers of sulphur, burning the sulphur in shal- 
low pans of sufficient number and size to rapidly fill 
the room with the fumes, and having quantities suffi- 
cient to last for several hours. Experience of the 
health officers in Michigan seems to have demonstra- 
ted that, in the ordinary homes of the people, in the 
manner above mentioned, and without the presence of 
the vapor of water, the specific cause of diphtheria is 
rendered incapable of causing diphtheria. This is a 
very important fact, because it enables us to disin- 
fect rooms without the destruction of much property 
which would be entirely ruined if the vapor of water 
were present. The combustion of sulphur should be 
rapid, and continue a considerable time. Care should 
be taken to secure the complete burning of as much 



TYPHOID FEVER 165 

of the sulphur as possible. To avoid danger of fire 
the iron pot or pan in which the sulphur is to be 
burned should be free from leaks, and should be 
placed over water in a tub or pan. 

If formaldehyde is used, at least eight ounces of a 
forty per cent solution, or not less than two ounces of 
the solidified formaldehyde should be used and vapor- 
ized, for each thousand cubic feet of air-space to be 
disinfected. After disinfection, the room and con- 
tents should be exposed for several hours, or days, if 
practicable, to currents of fresh air and sunshine. 



TYPHOID FEVER* 

Typhoid fever is a communicable disease of pro- 
tracted duration and found in all countries and under 
all conditions of climate. It is one of the preventable 
diseases, and sanitarians and physicians very generally 
agree that there is no cause for its existence in any 
community. This opinion is based upon a thorough 
knowledge of the nature and character of the disease, 
the well understood methods of infection and the 
further fact that it is often directly and positively 
controlled by modem measures. Notwithstanding 
this, there are between 350,000 and 400,000 cases of 
this disease with 35,000 deaths every year in the 
United States. Its widespread prevalence is due 
largely to public ignorance or indifference to the 
measures which can and should be taken to prevent it. 



♦Sanitary Bulletin, October, 1906, New Hampshire State Board of Health. 



i66 HOME CARE OF THE SICK 

While no age is exempt from the disease, the most 
susceptible period is between the ages of 20 and 30. 
After 30 years of age, there is a decrease of liability 
of infection up to 70 years of age, when it again 
increases to the extreme limit of life. 

Typhoid fever, although it exists at all seasons of 
the year, is more prevalent in the autumn months. 
Its greatest fatality is in September and October. 
The reason why typhoid fever should be more fatal 
in autumn ihan in any other period of the year is not 
well understood. Many theories have been advanced 
and some of the older ones abandoned. It is generally 
thought that -the summer heat and dryness are in some 
way responsible to a greater or less degree for the 
increased prevalence of this disease in autumn. It is 
probable that the cold weather following has a 
restrictive effect, so that upon its advent the disease 
rapidly diminishes. 

THE CAUSE OF TYPHOID FEVER. 

Typhoid fever is a germ disease — that is, it is 
produced hy a micro-organism, known as the typhoid 
bacillus. The growth and development of this germ 
take place within the body of the typhoid patient. 
It is always found in great abundance in the dis- 
charges of a person having typhoid fever, from the 
time of infection to weeks after convalescence is 
established. 

This germ always maintains its specific character, 



TYPHOID FEVER I67 

and when it finds its way into the body of a person 
who is susceptible, the disease is developed in some 
form between that of a so-called walking case, slightly 
indisposed, to the most malignant, fatal type. 

Formerly it was believed that typhoid fever was 
developed from general bad sanitary conditions, but 
this view is no longer entertained, the fact being that 
the seed must be sown, or, in other words, the par- 
ticular germ of the disease must be taken into the 
system before a true case of typhoid fever can be 
established, and this germ comes from some prior 
case. A further consideration of the subject will 
show the various ways in which this may happen. 

HOW TYPHOID FEVER IS SPREAD. 

The most frequent medium for the spread of 
typhoid fever is a polluted water supply, and it is to 
this source that substantially all of the great epidemics 
of typhoid fever have been traced. From a like 
source, also, spring a great number of individual 
cases, frequently classed as "sporadic," the water 
being contaminated from sewers, house drains, 
privy vaults, and other sources through which the 
typhoid fever germ may be transmitted. A water 
supply, whether well, stream, reservoir, or pond, 
that is polluted with human excreta, solid or fluid, 
is a dangerous supply, because of the liability of 
typhoid infection at any moment. It is therefore 
highly essential that all water supplies, both private 



i68 HOME CARE OF THE SICK - 

and public, should be guarded against pollution of 
this kind. 

Another source of typhoid fever is an infected milk 
supply. Outbreaks of the disease have occasionally 
appeared from this cause. Milk infection may take 
place through the addition of polluted water, or by 
washing the cans and other utensils with such water, 
or by the carelessness of milkers or others who handle 
the milk, whose hands or clothing may be infected. 

No milk should be distributed from a farm or dairy 
where there is a case of typhoid fever. 

Personal contact has been shown, by the commission 
appointed to investigate the spread of typhoid fever 
in the military camps during the Spanish War, to be 
a factor in the spread of this disease heretofore only 
partially recognized. In other words, the evidence 
shows that the disease was transmitted by persons not 
having the disease, infected bedding, clothing, eating 
and other utensils, and this to an extent that suggests 
the importance of most thorough disinfection of 
persons and things having any relation to a typhoid 
fever patient. 

Flies are also carriers of contagion. Food may be 
infected through their agency. Oysters and other 
shell-fish that came from sewage-polluted waters and 
were eaten uncooked have transmitted this disease in 
numerous instances. Typhoid infection has un- 
doubtedly been occasionally spread through vege- 
tables grown upon infected soil and eaten raw. 
Infection from such a source is possible. 



TYPHOID FEVER 169 

HOW TYPHOID GERMS ARE SCATTERED 

The media through which typhoid germs leave 
the body are the fecal discharges and the urine. 
The expectorations in some cases of pneumonia 
(typhoid-pneumonia, so called) also contain them. 
In all cases where complete and constant disinfection 
is not practised the organisms of this disease are 
often so disposed of as to endanger the water and milk 
supplies, and other food products. 

The so-called sporadic cases (individual cases, 
that cannot be directly connected with a prior case,) 
may readily be accounted for when the various ways 
in which the infection is distributed are understood. 

An interval of 10 or 12 days takes place between the 
inception of the germ and the development of the 
characteristic symptoms, during which time the 
patient is daily excreting the germs of the disease in 
countless thousands. During this period of incu- 
bation the patient is unknowingly scattering the 
infection, wherever he may be. 

There are also mild cases in which the. patient is 
under no restraint, and travels about as usual. Such 
a case continues often for weeks, and, with no pre- 
cautions taken, may cause a wide distribution of the 
germs of the disease. 

A third way in which the poison of typhoid is 
extensively distributed is by patients who have 
so far recovered from the disease as to be able" to 
travel about, or to assume their ordinary vocation, 



170 HOME CARE OF THE SICK 

it having been demonstrated that the germ in many- 
cases is present in the urine for weeks, and in some 
cases for months, after convalescence is established. 
It will, therefore, be seen that the typhoid fever germ 
is doubtless very widely scattered, and when this 
fact is understood, it does not require a great stretch 
of the imagination to account for individual, or so- 
called sporadic, cases. 

These facts, thoroughly established by scientific 
investigations, emphasize the great importance of 
enforcing disinfection in the sick-room constantly 
and to the minutest details and, further, of educating 
the patient that unless intelligent and effective 
precautions are taken he may be a source of danger 
to the community for some time after recovery. 

The typhoid germ is nearly always taken into the 
system with food or drink, especially with water, and 
multiplies enormously in the intestinal canal. It is 
cast out of the body in the stools and in the urine, and 
probably by no other channel. This is of the utmost 
importance in considering measures to prevent the 
disease. As stated above, this germ, or plant organ- 
ism, can live for some time after it leaves the body, 
just how long we do not know. In polluted soil, 
that is, earth containing much vegetable and animal 
matter undergoing decomposition, it may remain 
alive for several months, and possibly longer. Many 
soils possess excellent filtering properties, and remove 
practically all germs from water passing through 



TYPHOID FEVER 171 

them. Othersoilsfail to filter out these germs. A well 
with a privy in close proximity is always more or less 
dangerous, and many outbreaks of typhoid fever 
have been traced to this condition. The germs of 
typhoid fever may get into the well at its top. In a 
hilly or rolling country it is not uncommon to find the 
privy on higher ground than the well. The privy 
often has no vault, the stools and urine being 
deposited on the surface of the ground. If the stools 
or urine of a typhoid patient are thrown into the 
privy, the first rain-storm may wash the germs of 
the disease into the well. The roots of trees growing 
into a well may serve as conductors for contaminat- 
ing substances. A leaky drain near the well may 
pollute it. 

It is only since a few years that we have known 
that the germs of typhoid fever are often present in 
the urine of a person suffering from that disease. 
Formerly they were thought to be in stools, so that 
while the stools were carefully disinfected, and 
possibly buried at a distance from the well, no atten- 
tion was paid to the urine. The night vessel con- 
taining nothing but urine was often emptied near the 
well, where it was washed. We must now consider 
that the urine, from its liquid character, is even more 
dangerous than the stools. 

CARE OF A CASE 

A typhoid fever patient should be placed in a large, 



1/2 HOME CARE OF THE SICK 

airy room without a carpet or unnecessary furnish- 
ings. If there is diarrhoea, it is well to protect the 
bed with a rubber sheet, placed under the linen sheet.. 
The most scrupulous care should be taken of the 
discharges from the bowels and bladder. The stools 
or urine should be received in a vessel containing 
milk of lime , prepared by freshly slaking lime, using 
one part of the resulting powder or creamy liquid to 
four parts of water. Use a liberal quantity, and mix 
thoroughly by stirring with a stick. Fresh chloride 
of lime (it should " smell strongly of chlorine) , eight 
ounces to the gallon, may be used instead, or carbolic 
acid, seven ounces to the gallon. The contents of the 
vessel may then be thrown into the water closet or 
buried far from any well or spring. 

If the body linen or bed clothing should be soiled 
with the patient's discharges, they should be at once 
removed and placed in the carbolic acid solution; or, 
if the odor is objected to, in a solution of corrosive 
sublimate, a drachm to a gallon of water. After 
soaking an hour or more, they may be laundered, as 
usual. There is no disinfectant for clothing better 
than boiling water, and if soiled clothing can be 
promptly boiled this is the best treatment. 

The nurse should be exceeding careful about dis- 
infecting her hands immediately after handling the 
patient. The carbolic acid or corrosive sublimate 
solution will be suitable for this purpose, or Labar- 
raque's solution, one pint to a gallon of water, is 



TYPHOID FEVER 173 

efficient and pleasant. She should never eat or drink 
in the sick-room. As spoons, dishes, etc., used in the 
sick-room may become infected, it is well to disinfect 
these by boiling them in water for half an hour before 
they are used again. 

The disinfection of stools, clothing, etc., should be 
kept up until the patient has fully recovered. While 
it is not necessary to strictly isolate the patient, no 
needless visits to the sick-room should be allowed. 

In all outbreaks of typhoid fever of any considerable 
extent, there are, as a rule, many doubtful cases; 
persons who have fever for some d?ys, and possibly 
bowel symptoms, but who are not confined to the 
house. These cases should be dealt with as typhoid 
fever and taken care of, to secure efficient disinfection. 

Allow no flies to have access to sputum or discharges 
from the bowels and bladder, infected with typhoid 
fever. The disease is liable to be spread by flies, 
which go from infected excreta to bread, cake, and 
other food to be eaten uncooked. 

QUARANTINE UNNECESSARY 

It is entirely unnecessary to quarantine a case of 
typhoid fever, or the premises in which it exists, 
provided proper care is given to all the details of the 
sick-room, as recommended. 

The use of placards has been largely discontinued 
in this disease, and is not now required in this state. 

If disinfection is practiced as strictly as it should 



174 HOME CARE OF THE SICK 

be, there is no danger of the disease's being communi- 
cated to others from a given case ; but constant cleanH- 
ness and disinfection are absolutely necessary to 
secure such result. 

DISINFECTANTS 

For daily use in connection with a case of typhoid 
fever there are no better disinfectants than chloride 
of lime, and the milk of lime, formulas for which 
are given below. The milk of lime has the decided 
advantage of not having an objectionable odor. 

At the proper time, general disinfection of the sick- 
room should be carried out by the local board of 
health, using the formaldehyde process already 
recommended for this purpose. 

CHLORIDE OF LIME SOLUTION 

Chloride of lime (bleaching powder), one pound; 
water, three gallons. Mix. Cost, about three cents 
per gallon. 

Care should be taken to obtain fresh chloride of lime. 

This solution is so cheap that it can be used with 
great freedom, and it is one of the best disinfectants 
known. A quart or more per day may be used in an 
offensive vault, and such quantities as may be neces- 
sary in other places. It may be used in a sprinkler 
in stables and elsewhere. In the sick-room it may 
be used in vessels, cuspidors, etc. Sheets and other 
clothing used by the patient may be immersed in a 



TYPHOID FEVER 175 

pail or tub of this solution, diluted (one gallon of 
solution to ten of water), for two hours, or till ready 
for the wash-room or laundry. This solution is non- 
poisonous and does not injure white clothing. 

It may also be used for washing the hands or other 
parts of the body which may have been exposed to 
infection from excreta, etc. 

For a free and general use in privy vaults, sewers, 
sink-drains, refuse heaps, stables, and wherever else 
the odor of the disinfectant is not objectionable, this 
is one of the cheapest and most effective disinfectants 
and germicides available for general use. It should 
be used so freely as to wet everything required to be 
disinfected. Its odor does not disinfect — only covers 
up other odors. 

MILK OF LIME (qUICKLIME) 

Slake a quart of freshly burnt lime (in small pieces) 
with three fourths of a quart of water — or, to be 
exact, 60 parts of water by weight with 100 of lime. 
A dry powder of slaked lime (hydrate of lime) results. 
Make milk of lime not long before it is to be used by 
mixing one part of this dry hydrate of lime with eight 
parts (by weight) of water. 

Air-slaked lime is worthless. The dry hydrate 
may be preserved some time if it is enclosed in an 
air-tight container. Milk of lime should be freshly 
prepared, but may be kept a few days if it is closely 
stoppered. 



176 HOME CARE OF THE SICK 

Quicklime is one of the cheapest of disinfectants. 
This solution can take the place of chloride of lime, 
if desired. It should be used freely, in quantity equal 
in amount to the material to be disinfected. It can 
be used to whitewash exposed surfaces, to disinfect 
excreta in the sick-room or on the surface of the 
ground, in sinks, drains, stagnant pools, etc. 

Much of the so-called disinfection practiced in 
families is wholly inefficient and useless. The burn- 
ing of coffee, tar, sulphur, or other substance in the 
sick-room or in any other part of the house or prem- 
ises in the presence of the patient or other persons, 
operates, at most, only as a deodorizer, and does not 
destroy the germs of the disease. 

It should also be known that many of the prepara- 
tions offered for sale as disinfectants, germ killers, 
etc., are worthless, or nearly so, and should never be 
relied upon. 

Reliable formulas are given by which a family may 
make disinfectant solutions possessing the required 
strength and efficiency, and at a much less cost 
than is asked for proprietary preparations. 



"In olden days, no crime was so atrocious as that 
of poisoning wells, and even in times of war, the 
moral sense of those heathen nations was sufficient 
to prevent such a convenient way of destroying a 
nation's enemies. But in these days, one city 
poisons another's water supply without the least 



TYPHOID FEVER 177 

hesitation and with Httle or no protest except from 
the State Department of Health." — Monthly Bulletin, 
New York State Board of Health. 



"The time is not far distant when an epidenic 
of typhoid fever in any commonwealth will be 
just grievance for damage against the municipality 
allowing its existence. The water and milk supply 
are the great sources of infection, and by adopting 
proper sanitary and hygienic measures along these 
lines typhoid fever can be wiped out." — Wisconsin 
State Board of Health Bulletin. 



FORMALDEHYDE DISINFECTION — A NEW 
PROCESS* 

A long series of experiments in the Laboratory of 
Hygiene have developed the fact that formaldehyde 
may successfully and very conveniently be used in 
the disinfection of the rooms with the use of no lamps, 
generators, or other special apparatus whatever. 
In the process which has been employed in this work, 
formaldehyde gas is libera;ted by pouring formalde- 
hyde upon permanganate of potassium. At ordi- 
nary room temperatures a chemical reaction results 
whereby a high degree of heat is evolved. This 
fieat causes an effervescence or boiling, and formalde- 
hyde gas is given off very rapidly. 

The advantages of this method are, that the dis- 
infecter need not transport apparatus from place to 
place ; that there is no generator or lamp which might 
originate a fire; that almost the whole quantity of 
formaldehyde available for disinfection is liberated 
in a few moments, thus giving the maximum concen- 
tration of the gas before there has been time for 
leakage of the part first evolved; that, through the 
action of the heat liberated by the chemical reaction, 
a sufficient quantity of steam goes off wih the formal- 
dehyde to insure efficient disinfection. 

In carrying out this process of disinfection the 



♦Circular No. 75, State Board of Health of Maine. 
178 



FORMALDEHYDE DISINFECTION 179 

requisites are simply the ordinary so-called 40 per 
cent formaldehyde solution, commercial perman- 
ganate of potassium, and a vessel to mix them in. 

The required quantity of permanganate for each 
pint of formaldehyde is 7>^ ounces. The perman- 
ganate is first put into the dish and the formaldehyde 
is then poured upon it. The permanganate must go in 
first. Before the mixture is made everything must 
be in readiness, because a rapid flight from the room 
must be made. Leave the room closed up tightly four 
hours. 

The vessel in which the permanganate and formal- 
dehyde are to be mixed should be of considerable 
size, else the vigorous foaming will throw a part of 
the mixture upon the floor. A flaring ten-quart 
tin pail is a suitable and large enough vessel unless 
more than three pints of formaldehyde are to be used, 
and even then until the disinfecter is well acquainted 
with this process, it would be a safe precaution to 
set the pail inside of a large pan. In this, as in all 
methods of chemical disinfection, the disinfectant 
action is more efficient the warmer the room. 

As it is necessary to adjust carefully the relative 
quantities of permanganate and formaldehyde, and 
as it is much more convenient to measure the per- 
manganate than to weigh it, arrangements have 
been made with some of the druggists to keep in 
stock a small tin measure holding 3^ ounces of 
permanganate, "strick" measure, not shaken down. 



i8o HOME CARE OF THE SICK 

The rule is, in ordinary disinfection: for each looo 
cubic feet of room space to be disinfected, two 
measurefuls of permanganate and one pint measureful 
of formaldehyde. 

A large quantity of formaldehyde and a shortened 
time of exposure are more efficient and generally 
more economical than a smaller quantity of formal- 
dehyde and a lengthened period of exposure. It is 
a saving to families that have to submit to disinfection 
to have the time shortened, and is much more satis- 
factory to them. With the time at four hours, 
formaldehyde fumigation may be completed in the 
forenoon and the rooms may have a lengthened 
airing in the aftemooon so the family may occupy 
their rooms the same evening The state board 
of health now makes the following recommendations: 

I. In ordinary disinfection, when the infection to 
be destroyed is that of typhoid fever, diphtheria, 
scarlet fever, small-pox, measles, grippe, whooping- 
cough, dysentery or cholera, use one pint of formal- 
dehyde for each looo cubic feet of space to be disin- 
fected. Though a considerably smaller quantity 
was found efficient in the experimental work, allow- 
ance must be made for unusual leakage from rooms, 
for low temperature, for insufficient moisture, for 
inaccessibility of parts of the infection, etc. It is 
necessary to have quite a wide margin for safety, but 
the quantities herein advised provide for that margin 
if the work is intelligently done. 



FORMALDEHYDE DISINFECTION i8i 

2. When the infection to be destroyed is the more 
resistant micro-organisms of tuberculosis, or of 
specticemia, a pint and a half of formaldehyde 
(formalin) per looo cubic feet of space should be 
used. The same quantity at least should be used in 
the disinfection of books, clothing, and in all cases in 
which the infection is not entirely open and accessible 
to the gas, that is, when some degree of penetration 
must be secured. 

The experiments have shown that, used as is herein 
recommended, formaldehyde gas has some consider- 
able power of penetration; nevertheless, the state 
board of health does not yet deem it safe to advise 
any marked departure from the general method of 
disinfection given in its circulars on the infectious 
diseases — scrubbing up of floors, boiling the 
cotton and linen clothing of the patient and of his bed 
and such other badly infected articles as can thus be 
treated, or soaking them in a disinfecting solution. 



SUPPLEMENTAL PROGRAM ARRANGED FOR CLASS 
STUDY ON 

HOME CARE FOR THE SICK 



MEETING I 

(Study pages 1-13) 
Symptoms of Disease 

See Care of Children, pages 153-159, for children's dis- 
eases. (Vol. XI of the Library of Home Economics.) 
The Sick-Room. 

See Household Hygiene, Ventilation and Heating, 
Home Nursing, Harrison, pages 1-13. ($1.00, post- 
age IOC.) 

MEETING II 

(Study pages 13-34) 
Care of the Patient 

Make bed with draw-sheet, as described in the text. 
Change the bed as described. 
Lift patient to sitting position. 
Make back rest and foot brace. 

Change patient from one bed to another, two methods. 
Change mattress with patient in bed. 
Make a wadding ring to relieve pressure. 
If possible, get a trained nurse to show how these things 
are done. 
Convalescence 

Lift patient into a chair. 

Topic — Amusing the convalescent and sick children. 

MEETING III 

(Study pages 34-62.) 
Baths and Bathing 

Make up pitcher of water, cool, tepid, warm, etc., of 
the various degrees of temperature given on page 41. 

183 



l84 HOME CARE OF THE SICK 

Test with a bath or other thermometer and with the 
hand. Note how unreliable the hand may be; after 
the hand has been in the cold water, the tepid water 
feels warm, and after having been in the hot water, 
the tepid water feels cold. 

Home Nursing, Harrison, pages 63-73. ($1.00, post- 
age IOC. 

Practical Points in Nursing, Emily Stoney, pages 83-93 
($1.75, postage 20c.) 
Temperature, Pulse, Giving Medicine, etc. 

Obtain a clinical thermometer and take temperature a 
number of times, having all read the thermometer 
to I- 1 oof a degree, and write the reading on slips of 
paper. Compare results. If there is any difficulty 
in shaking down the niercury, get a physician or 
nurse to show how it is done. A clinical thermometer 
may be purchased through the School for $1.25,- 
or will be loaned for loc. 

Count the pulse in quarters for a second, as described, 
and compare results as in the taking of temperature. 

Count the respiration, as directed. 

Have an exhibit of medicine glasses, feeding cups, 
syringes, ice-caps. 

Make poultices, sinapisms, flannel for fomentations, 
compresses. 

(Select answers to the Test Questions on Part I and send 
to the School. Report on Meetings I, II, and III.) 

MEETING IV 

(Study pages 63-73) 
Contagious Diseases : Disinfection 

See article in the supplement, also send for and read 
some of the following Bulletins issued by State 
Boards of Health: 



PROGRAM 185 

Lansing, Michigan, "Dangerous Communicable Dis- 
eases. " 
Concord, New Hampshire, "Consumption.'' 
Springfield, Illinois, "Consumption'' also "Practical 

Disinfection. ' ' 
Augusta, Maine, "Contagious Diseases." 
Trenton, New Jersey, "Restriction of the Spread of 

Infectious Diseases." 
These Bulletins are sent free, or for a 2c stamp. Send 
to your own State Board of Health, if not included 
in the above; to your capital city, for any Bulletins. 

MEETING V 

(Study pages 73-105) 
Surgical Work: Obstetrics 

Practical Points in Nursing, Stoney, ($1.75, postage 20c.) 
Food for the Sick 

Food and Cookery for the Sick and Convalescent. 
($1.50, postage i8c.) 

Food for the Sick, French, ($1.00, postage loc.) 

Hand Book of Invalid Cookery, Boland, ($2.00, post- 
age 1 6c. 

Collect appropriate recipes in addition to those given 
in the text. 

Show dainty and suitable serving for the sick, 

MEETING VI 

(Study pages 105-121) 
Emergencies 

Practice artificial respiration, as described. 
Make a tourniquet. 
Bandaging and Bandages . 

Practice all the bandages described. If possible, get 

a trained nurse to show methods. 
(Select answers to the Test Questions on Part II and 
report on Meetings IV, V, and VI.) 



INDEX 



Air cushion, rubber, 29 
Airing the sick room, 12 
Amusing patient, 3 1 
Antidotes for poisons, 113 
Artificial respiration, 108 

skin, 27 
Ashes, removing, 13 
Asphyxiation, 109 

Baby, care of, 91 
Back rests, 22 
Bandages, 114 

capeline, 117 

foot, 115 

forehead, 117 

four tailed, 118 

leg, 116 

materials for, 114 

of the hand, 118 
Bandaging, 114 

kinds of, 115 
Bath thermometer, 37 
Baths, 34 

cleansing, 34 

foot, 35 

hot, 37 

salt, 40 

temperature for, 41 

to reduce temperature, 36 
Bed, the, 9 

changing, 16 

height of, 9 

making, 15 

size of, 9 
Bed sores, 25 

care of, 28 
Bibliography, 122 
Bichloride of mercury, 64 
Blood poisoning, 109 



Brand treatment, 36 
Bums, 106 

Carbolic acid, 64 
Care of nurse, 13 

of patient, 13 

of sick-room, 9 
Catheterization, 57 
Changing mattress with pa- 
tient in bed, 25 

patient from one bed to 
another, 23 

position of patient, 22 
Chickenpox, 3 
Choice of sick-room, 9 
Cholera infantum, 5 
Climate in consumption, 139 
Colic, 4 

treatment for, 4 
Collodion, 27 
Compresses, 62 
Consumption, 65, 127 
Contagion, 63 
Contagious diseases, 2,67 
Convalescence, 29 

diet in, 29 
Convulsions, 5 
Coughing, 125 
Croup, 6 

false, 6 

membranous, 6 
Cure of bed sores, 25 

Diet in convalescence, 29 

special, 95 
Diphtheria, 4, 153 

cause of, 153 



187 



HOME CARE OF THE SICK 



Diphtheria, precautions in, 

prevention of, 154 
Diseases, children's, 4 

contagious, 2 

not contagious, 4 

preventable, 125 
Disinfectant solutions, 64 
Disinfectants, 63 
Disinfection, 63, 65, 152, i 

at termination of disease, 

formaldehyde, 177 

of clothes, 68 

of dishes, 68 

of patient, 70 

of room, 71 

personal, 72 

special rules for, 69 
Dislocations, 11 1 
Doctor, province of, i 
Douches, 56 
Draw sheet, 15 

changing, 16, 19. 
Drowning, 107 
Dusting, II 

Ear, foreign bodies in, 112 
Emergencies, 105 
Enema, cleansing, 54 

soap, 55 
Enemata, nutritive, 52 
Epilepsy, 107 
Epistaxis, no 
Eyes, care of, 73 

foreign bodies in, 112 

Fainting, 106 
Fever, scarlet, 4 

typhoid, 5, 165 
First aid to injured, 105 
Floor of sick-room, 11 
Flowers in sick-room, 9 
Fomentations, 61 
Food for sick, 93 



155 Food, highly seasoned, 30 
Foot brace, "22 

Formaldehy dedisinfection, 177 
Foreign bodies, 112 
in ear, 112 
in eye, 112 
in nose, 112 
in windpipe, 112 
61 Fractures, in 
70 Frost bites, 106 

Fuel in sick-room, 13 
Furnishings of sick-room, 9 

German measles, 3 
Go\vns, short, 20 

Hair, care of, 32 

washing, 33 
Hemorrhage, 90, no 

from lungs, no 

signs of, 79 
High temperature, 43 
Hot pack, 37 
Hypodermic injections, 53 

Ice caps, 61 

Incubation, period of,' 2 
Infectious diseases, 64 
Inhalations, 53 

steam, 6 
Injections, 50 

hypodermic, 53 
Intestinal obstruction, 5 
Isolation, 67 

time of, 3 

Lifting patient, 20, 23, 32 
Lighting of sick-room, 10 
Lung diseases, 135 

Mattresses, 9 
changing, 25 
protecting, 16 



INDEX 



189 



Meals, serving, 29 
Measles, 3 

German, 3 
Measuring glasses, 49 
Medicines, giving of, 48 
Membranous croup, 157 
Meningitis, 6 
Mother, province of, 1 
Mouth, care of, 33 

washes, 34 
Mumps, 2 
Mustard plasters, 60 

Night gown, changing, 18 
Night, nursing at, 14 
Nose bleed, no 
Nose, foreign bodies in, 112 
Nurse, care of, 13 

clothing of, 14 

duties of, I 

night, 14 
Nursing the baby, 92 

Obstetrics, 80 
Operating room, 75 

table, 75 
Operations, 73 

precautions when over, 78 

preparation for, 74 

Patient, amusing, 31 

care of, 13 
■ lifting, 20, 32 
Pillows, 28 
Pills, 50 
Pneumonia, 5, 145 

precautions in, 147 

spread of, 146 

symptoms of, 5 
Poisoning, blood, 109 
Poisons, 113 
Poultices, 59 

applying, 59 



Poultices, linseed, 59 

starch, 60 
Powders, giving, 50 
Pressure, relieving, 28 
Preventable diseases, 125 
Prevention of bed sores, 25 
Program for supplemental 

study, 181 
Pulse, 44 

counting the, 45 

Quarantine, 70 

Recipes, 97 
Records, keeping, 46 
Relapse, cause of, 29 
Respiration, 46 

artificial, 108 

chart, 46 
Rubber air cushion, 29 

sheet, 16 

Scalds, 106 
Scarlet fever, 4 
Scultelus bandages, 120 
Serving, dainty, 29, 96 
Sheet, changing, 18 

draw, 15 

rubber, 16 
Shock, 107 
Sick-room, 9 

airing, 12 

care of, 9, 134 

choice of, 9 

don'ts, 14 

dusting, Ti 

floor of, 1 1 

furnishing of, 9 

lighting of, 10 

methods, 41 

sweeping, 11 

temperature of, 13 

ventilation of, 12 
Sinapisms, 60 



:9o 



HOME CARE OF THE SICK 



Skin, artificial, 27 

care of, 27 
Slings, 121 
Smallpox, 3 
Spitting, 127, 147 
Sprains, 11 1 
Sterilized water, 77 
Sterilizing dressings, 76 

the hands, 78 
Suppositories, 52 
Surgical operations, 73 
Sweeping, 11 
Symptoms, first, 2 
Syncope, 106 

Table, 10 

bedside, 11 

of contagious diseases, 2 
Teeth, care of, 33 
Temperature, 43 

high, 43 

normal, 43 



Temperature of sick-room, 13 

records, 44 

sub-normal, 43 
Temperature, taking the, 42 
Thermometer, bath, 37 

clinical, 41 
Tourniquet, no 
Tuberculosis, 65, 129 
Turning patient, 19 
Typhoid fever, 5, 165 

care of patient in, 171 

cause of, 165 

spread of, 167 

Ventilation, 12 
window, 12 

Wadding ring, 28 

White plague, the great, 141 

Windpipe, foreign bodies in, 

112 
Wounds, 109 



SUE COPY BECffilS 

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